Hysteroscopic Uterine Septum Surgery

What Is the Uterine Septum and Why Is It Important?

The uterine septum is a congenital uterine anomaly that occurs when the middle wall (septum) formed during the fusion of the two Müllerian ducts in embryonic development fails to fully resorb. This septum can extend to varying lengths from the top of the uterus down to the cervix (partial or complete septum) and can divide the uterine cavity into two separate compartments.

The significance of this condition stems from its negative effects on the uterus’s capacity to carry a pregnancy:

• Insufficient Blood Supply: The tissue forming the septum is usually not as well vascularized as the normal uterine wall. If the embryo implants in this area, it may not be adequately nourished, which can result in miscarriage.
• Reduced Uterine Cavity Volume: The septum narrows the internal volume of the uterus, which can leave insufficient space for the growing fetus and lead to preterm birth.
• Irregular Uterine Contractions: The presence of the septum can cause irregular uterine contractions during or before labor.

What Is the Uterine Septum and Why Is It Important?

The uterine septum is a congenital uterine anomaly that occurs when the middle wall (septum) formed during the fusion of the two Müllerian ducts in embryonic development fails to fully resorb. This septum can extend to varying lengths from the top of the uterus down to the cervix (partial or complete septum) and can divide the uterine cavity into two separate compartments.

The significance of this condition stems from its negative effects on the uterus’s capacity to carry a pregnancy:

• Insufficient Blood Supply: The tissue forming the septum is usually not as well vascularized as the normal uterine wall. If the embryo implants in this area, it may not be adequately nourished, which can result in miscarriage.
• Reduced Uterine Cavity Volume: The septum narrows the internal volume of the uterus, which can leave insufficient space for the growing fetus and lead to preterm birth.
• Irregular Uterine Contractions: The presence of the septum can cause irregular uterine contractions during or before labor.

What Are the Effects of the Uterine Septum on Pregnancy and Fertility?

The presence of a uterine septum can have several adverse effects on fertility and the course of pregnancy:

• Recurrent Pregnancy Loss: This is the most commonly associated problem. The risk of miscarriage increases, particularly in the first trimester.
• Infertility: It can cause difficulties with embryo implantation in the uterus.
• Preterm Birth: Due to the insufficient uterine cavity volume, the risk of the pregnancy ending prematurely increases.
• Abnormal Fetal Position: The baby presenting breech or transverse rather than head-down (presentation anomaly) may be more common, which can increase the need for a cesarean section.
• Growth Restriction: Although rare, it can contribute to the baby not growing adequately in the uterus.

For this reason, it is very important to investigate the presence of a uterine septum, especially in women with a history of unexplained infertility or recurrent pregnancy loss.

Diagnostic Methods: How Is the Uterine Septum Diagnosed?

A uterine septum is usually not detected during a routine gynecological examination. More detailed imaging methods are used for diagnosis:

• Transvaginal Ultrasonography (TVUS): Especially three-dimensional (3D) ultrasonography is highly effective for visualizing the internal structure of the uterus and any septum. It has a high accuracy rate when performed by an experienced specialist.
• Hysterosalpingography (HSG): An X-ray taken after injecting contrast material into the uterus. It shows the shape of the uterine cavity and the patency of the tubes, and may suggest the presence of a septum, but it may not be sufficient for a definitive diagnosis and may have difficulty distinguishing the septum from other uterine anomalies (e.g., bicornuate uterus).
• Magnetic Resonance Imaging (MRI): A powerful imaging method that shows the uterine structure and surrounding tissues in detail. It can be used especially in complex cases or when other methods are insufficient.
• Hysteroscopy: This involves directly viewing the inside of the uterus with a camera. It is considered the gold-standard method both for confirming the diagnosis and for performing treatment (surgery) in the same session. This method is frequently used at our clinic in Ankara.

Hysteroscopic Septum Treatment: A Modern and Effective Solution

The current and most effective treatment for a uterine septum is the closed surgical technique called hysteroscopy. This minimally invasive approach is performed through the vaginal route without any incision to the abdomen. The main goal of the surgery is to cut and remove the septum dividing the interior of the uterus, giving the uterus a single, unified, healthy cavity. This provides a suitable environment for embryo implantation and development, increases the chance of pregnancy, and reduces the risk of miscarriage.

What Are the Step-by-Step Stages of Hysteroscopic Uterine Septum Surgery?

Hysteroscopic septum resection generally involves the following steps:

1. Anesthesia: The procedure is usually performed under general anesthesia, so the patient does not feel any pain or discomfort. In some cases, regional anesthesia may also be preferred.
2. Cervical Dilation: The cervix is carefully dilated to a certain degree so the hysteroscope can enter the uterine cavity.
3. Insertion of the Hysteroscope: The hysteroscope, a thin tube with a camera and light source at its tip, is passed through the vagina and cervix and advanced into the uterine cavity.
4. Visualization of the Uterine Cavity: A sterile fluid (such as saline) is typically used to distend the uterine cavity and provide a clear view. The camera images are projected onto a screen, allowing the surgeon to examine the interior of the uterus, the septum, and the tubal openings in detail.
5. Resection of the Septum: The septum is carefully and precisely cut using special surgical instruments passed through the hysteroscope (typically a thin energized wire loop or a laser fiber). The cutting is usually performed from the base of the septum toward the top of the uterus.
6. Completion of the Procedure: Once the septum has been fully divided and the uterine cavity unified, the instruments are removed. Bleeding is checked. The procedure is usually completed within 30 to 60 minutes.

Who Is a Candidate for Hysteroscopic Uterine Septum Surgery?

This surgery is generally recommended in the following situations:

• Women with a history of recurrent pregnancy loss (generally 2 or more miscarriages) who are found to have a uterine septum.
• Women experiencing unexplained infertility who are found to have a uterine septum.
• Women with a history of preterm birth attributable to a uterine septum.
• Women found to have a septum prior to IVF treatment, in order to improve the chances of embryo implantation.

The decision to operate is made on an individual basis by Prof. Dr. Nuray Bozkurt after a detailed evaluation that takes into account the patient’s history, the size and type of the septum, and additional factors.

What Are the Advantages of the Closed (Hysteroscopic) Surgery?

There are many reasons why the hysteroscopic (closed) method is preferred:

• Minimally Invasive: There is no incision or stitching on the abdomen, which is advantageous cosmetically.
• Less Pain: Postoperative pain is significantly less compared to open surgery.
• Rapid Recovery: Patients can usually be discharged the same day or the next day and can return to their normal daily activities within a few days.
• Short Operating Time: The procedure is generally quick.
• Low Complication Rate: Risks such as infection and bleeding are lower than with open surgery.
• High Success Rate: This method is highly successful in increasing pregnancy rates and reducing the risk of miscarriage.
• Preservation of Fertility: Because the intervention to the uterine structure is minimal, fertility potential is preserved and even improved.

Preoperative Preparation and Postoperative Recovery

• Preparation: Before the surgery, your doctor will assess your general health and order the necessary blood tests. It is important to inform your doctor about any medications you are taking. The surgery is usually scheduled for the first few days after your period ends, when the lining of the uterus is thinnest.
• Recovery: Mild pelvic pain, spotting, or watery discharge may last a few days after surgery. Your doctor may prescribe pain relievers and, if needed, antibiotics. Generally, 1-2 days of rest is sufficient. It is recommended to avoid sexual intercourse and strenuous exercise for the period your doctor advises (usually a few weeks). Recovery is monitored with a follow-up examination.

Possible Risks and Points to Consider

Although hysteroscopic uterine septum surgery is generally a safe procedure, as with any surgical intervention there are some potential risks, though they are rare:

• Infection
• Bleeding
• Perforation of the uterine wall (uterine perforation)
• Complications related to the fluid used to distend the uterine cavity (fluid overload)
• Anesthesia-related risks
• Intrauterine adhesions (rare)

These risks are minimized when the surgery is performed by an experienced surgeon at a properly equipped center. Prof. Dr. Nuray Bozkurt will inform you in detail about the possible risks and the precautions to be taken before the surgery.

A Safe and Successful Treatment Process with Prof. Dr. Nuray Bozkurt in Ankara

Gynecology and Obstetrics Specialist Prof. Dr. Nuray Bozkurt has extensive experience in uterine anomalies and advanced hysteroscopic surgical techniques. At her modern clinic in Ankara, she offers her patients a personalized, compassionate treatment approach grounded in scientific evidence. Standing by you at every step from diagnosis through treatment and follow-up, she provides the support you need to regain your health and reach your pregnancy goals. With our technological infrastructure and experienced team, we perform hysteroscopic septum surgery safely.

If you have been diagnosed with a uterine septum, are experiencing recurrent miscarriages, or this condition was identified during infertility investigations, you can contact our clinic in Ankara to learn more and discuss treatment options tailored to you. You can schedule an appointment for a one-on-one consultation and detailed evaluation with Prof. Dr. Nuray Bozkurt. Do not hesitate to take the first step toward a healthy future and pregnancy.