Uterine Septum Surgery

What Is a Uterine Septum?

A uterine septum, is a congenital structural anomaly that partially or completely divides the uterine cavity into two. This condition arises as a result of a fusion defect that occurs during the formation of the uterus while the baby is developing in the womb.

Normally, the uterus is formed from two separate structures during the embryonic period, and these structures fuse to become a single cavity. However, if the tissue in the middle does not completely disappear during this fusion, a “septum” forms inside the uterus. This septum divides the internal volume of the uterus and can affect the course of pregnancy.

In some women, a uterine septum may cause no symptoms at all and may be noticed incidentally. However, in some cases it can lead to problems such as recurrent miscarriages, difficulty conceiving, and preterm birth. Structural problems inside the uterus are an important subject of evaluation in patients planning a pregnancy.

A uterine septum is a condition that can be brought under control when correctly diagnosed and appropriately treated. For this reason, its evaluation is important, especially in patients experiencing recurrent pregnancy losses.

What Causes a Uterine Septum?

A uterine septum arises as a result of a variation that occurs during the formation of the uterus while the baby is developing in the womb. This condition is an entirely congenital anomaly.

During the embryonic period, the uterus develops from two separate structures called the “Müllerian ducts.” In the normal process, these ducts fuse to form a single uterine cavity, and the tissue in between disappears over time. However, in some cases these two ducts do not fully fuse, or even if they fuse, the tissue in the middle does not completely resolve; in this case, a septum forms inside the uterus.

The formation of a uterine septum is generally linked to genetic or developmental factors. However, in most cases no definite cause can be identified. This condition does not develop later in life; it is present from birth, and most people may not notice this structural variation for years. This structure inside the uterus becomes particularly important during pregnancy, because it can affect the implantation area of the embryo and can lead to certain risks in pregnancy.

What Are the Types of Uterine Septum?

A uterine septum is classified into different types according to the length of the septum inside the uterus and how much it divides the uterine cavity. This classification is important for determining both the severity of the symptoms and the treatment plan.

• Partial Septum: A septum structure that does not completely divide the uterine cavity and is present only in its upper part. It generally follows a milder course and may cause no symptoms in some patients; however, it can still create a risk of miscarriage.
• Complete Septum: A more advanced condition in which the uterine cavity is completely divided into two. It creates a higher risk with respect to pregnancy and is more frequently associated with recurrent miscarriages.

The type of uterine septum is particularly important in patients planning a pregnancy, because the larger and deeper the septum is, the more pronounced its effects on pregnancy can be.

What Are the Symptoms of a Uterine Septum?

A uterine septum can often progress without symptoms and be noticed incidentally. However, in some cases it can lead to complaints that become evident especially during pregnancy. The most common symptoms are:

• Recurrent miscarriages
• Difficulty conceiving (infertility)
• Risk of preterm birth
• Pain during menstruation (dysmenorrhea)
• Menstrual irregularities (in some patients)

Many women with a uterine septum may experience no symptoms in daily life. However, once a pregnancy occurs, this structure can make it harder for the embryo to implant healthily inside the uterus. A uterine septum should definitely be evaluated, especially in patients experiencing recurrent pregnancy loss.

How Does a Uterine Septum Affect Pregnancy?

A uterine septum is an important structural condition that can directly affect the course of pregnancy. This septum dividing the inner cavity of the uterus can make it harder for the embryo to implant and develop healthily. Normally, the embryo implants in a well-vascularized area of the uterus and continues its development. However, in people with a uterine septum, since the blood supply of the septum tissue may be poor, sufficient nourishment may not be provided when the embryo implants in this area.

The effects of a uterine septum on pregnancy include an increased risk of recurrent miscarriage, implantation problems for the embryo, a risk of preterm birth, positional abnormalities of the baby inside the uterus, and the pregnancy not progressing healthily. These risks become more pronounced especially in the presence of a complete septum.

Not every woman with a uterine septum experiences pregnancy problems. However, in patients who experience pregnancy loss or problems during pregnancy, this condition can be an important cause. With early diagnosis and appropriate treatment, pregnancy problems related to a uterine septum can be reduced to a large extent.

Does a Uterine Septum Cause Infertility?

A uterine septum does not always directly cause infertility. However, in some cases it can make it harder for the embryo to implant inside the uterus, adversely affecting the establishment or the continuation of a pregnancy. The septum inside the uterus can create a surface unsuitable for embryo implantation; in particular, since the blood supply of the area where the septum is located is poor, the embryo may not be able to develop healthily when it implants in this area.

The effects of a uterine septum on fertility include making it harder for the embryo to implant in the uterus, increasing the risk of miscarriage even if a pregnancy occurs, and causing recurrent pregnancy losses. Infertility is not seen in every patient with a uterine septum; some women can achieve pregnancy without any problems. However, in cases of recurrent miscarriage or unexplained infertility, a detailed examination of the uterine structure is required.

When a uterine septum is detected and there is a pregnancy plan, in suitable cases this structure can be corrected with surgical treatment. In this way, the chance of pregnancy can be increased.

How Is a Uterine Septum Diagnosed?

A uterine septum is often not noticed during a routine gynecological examination. For this reason, imaging methods are used to make the diagnosis. Detailed examination is important, especially in patients planning a pregnancy or experiencing recurrent miscarriage.

• Ultrasonography (USG): The first evaluation method. It provides general information about the uterine structure. 3D ultrasound in particular shows the internal structure of the uterus in more detail.
• Hysterosalpingography (HSG): Known as a uterine X-ray. It provides information about the shape and structure of the uterine cavity. The septum inside the uterus can be seen with this method.
• Magnetic Resonance Imaging (MRI): Provides more detailed imaging. It is used especially in the differential diagnosis of uterine anomalies.
• Hysteroscopy: A method that allows the inside of the uterus to be viewed directly with a camera. It is one of the most definitive methods for diagnosis and can also be used for treatment purposes.

Correctly diagnosing a uterine septum is of great importance for determining the treatment plan. In particular, it must not be confused with other uterine anomalies. With a uterine septum, the outer shape of the uterus is generally normal while the inner cavity is divided by a septum; with a bicornuate uterus, on the other hand, the outer structure of the uterus also appears indented or two-part, and a congenitally different structure is involved. Distinguishing between these two conditions directly affects the treatment approach.

How Is a Uterine Septum Treated?

The treatment of a uterine septum is evaluated according to the patient’s complaints and pregnancy plans. Small septa that cause no symptoms and create no pregnancy-related problems may not always require treatment. However, treatment is recommended especially in patients experiencing recurrent miscarriage or pregnancy loss.

The most effective method in the treatment of a uterine septum is surgery (hysteroscopic metroplasty). Today, this procedure is mostly performed with hysteroscopy, that is, with a minimally invasive method. During this procedure, the uterus is entered with a thin camera, the septum tissue is cut and removed, and the uterine cavity is restored to its normal structure.

The advantages of hysteroscopic surgery include being a minimally invasive method (there is no incision), a short hospital stay, fast recovery, and the potential to increase the chance of pregnancy.

Hysteroscopic uterine septum surgery is a minimally invasive surgical procedure in which the septum inside the uterus is cut and removed under camera guidance. It is performed through the vaginal route, requires no external incision, and is usually completed in a short time. During the operation, the inside of the uterus is directly visualized while the procedure is performed; this provides the possibility of a more precise and safer intervention.

The Process and Risks After Uterine Septum Surgery

The recovery process after the operation is generally fast. Patients can return to daily life in a short time; mild pain and spotting may be seen. It is important to follow the doctor’s recommendations. Pregnancy can generally be planned a certain period after the operation.

Hysteroscopic surgery is a safe method when performed by experienced hands. However, as with any surgical procedure, there can be some risks: infection, bleeding, and rarely intrauterine adhesions. These risks are generally low and are minimized with appropriate technique.

The chance of pregnancy generally increases after uterine septum surgery. Especially in patients experiencing recurrent miscarriage and in people with embryo implantation problems, healthier pregnancies can be achieved after the operation. For this reason, with correct patient selection and appropriate treatment, the likelihood of a favorable outcome is quite high.

What Happens If It Is Not Treated?

While an untreated uterine septum causes no problems in some patients, in some cases it can lead to serious pregnancy problems. Possible consequences include recurrent miscarriages, pregnancy loss, preterm birth, and pregnancy complications. For this reason, its evaluation is important, especially in patients planning a pregnancy.

A uterine septum is a congenital structural condition and does not disappear on its own; this structure can only be corrected with surgical intervention.