Clinical implications of uterine malformations and hysteroscopic treatment results

Uterine malformations consist of a group of miscellaneous congenital anomalies of the female genital system. Their mean prevalence in the general population and in the population of fertile women is ∼4.3%, in infertile patients ∼3.5% and in patients with recurrent pregnancy losses ∼13%. Septate uterus is the commonest uterine anomaly with a mean incidence of ∼35% followed by bicornuate uterus (∼25%) and arcuate uterus (∼20%). It seems that malformed uterus and especially septate uterus is not an infertility factor in itself. However, it may have a part in the delayed natural conception of women with mainly secondary infertility. On the other hand, patients with uterine malformations seem to have an impaired pregnancy outcome even as early as their first pregnancy. Overall term delivery rates in patients with untreated uterine malformations are only ∼50% and obstetric complications are more frequent. Unicornuate and didelphys uterus have term delivery rates of ∼45%, and the pregnancy outcome of patients with untreated bicornuate and septate uterus is also poor with term delivery rates of only ∼40%. Arcuate uterus is associated with a slightly better but still impaired pregnancy outcome with term delivery rates of ∼65%. Women who have undergone hysteroscopic septum resection and have been reported in the different series comprise a highly selected group of symptomatic patients with term delivery and live birth rates of only ∼5%. Hysteroscopic treatment seems to restore an almost normal prognosis for the outcome of their pregnancies with term delivery rates of ∼75% and live birth rates of ∼85%. It seems, therefore, that hysteroscopic septum resection can be applied as a therapeutic procedure in cases of symptomatic patients but also as a prophylactic procedure in asymptomatic patients in order to improve their chances for a successful delivery.