Improved fertility of couple after the hysteroscopic metroplasty

M. Niculescu, L. Hodovanu, V. Dinu, C. Cristescu

Abstract: Among of couples with reproductive disordes, the congenital uterine malformations are more frecvently causes of infertility from miscarriage instead of difficulty in achieving conception, because hinder rather pregnancy instead conception. Being the most common congenital malformation, the septate uterus is responsable for the biggest rate of recurrent spontaneous abortions and preterm delivery because the patology of the uterus. Because the most septate uteri are asymptomatic, there are discovered at the full-age, either by routine pelvic examination or by investigation of infertility of couples. Because only the septate uterus is amenable to hysteroscopic metroplasty, the main difficulty is differentiation from bicornuate uterus. The distinction must be made by demonstrating a normal external fundal countour with an uterine septum, an opposed to the presence of two uterine horns in a bicornuate uterus. But the inspection and the vaginal examination don’t discover the uterine anomalie because there isn’t a fundal notching, palpated abdominally, it is compulsory to use a standard protocol from investigation, that will compose of an hysterosalpingogram or a sonohysterography, an high-resolution transvaginal sonography and an hysteroscopy. Laparoscopy may be necessary for confirmation of the absence or presence of an external division of the uterus, in selected cases and depending on the practical routine of the hospital. The histeroscopic metroplasty may be done by three ways: it is being divided by a hysteroscopic rigid scissor, it is cut by an electric monopolar needle or with the loop of resectoscopes. Pregnancy outcome is equal with all three methods of septum division; usually,the method used depends on practical routine and the experience of surgeon with those technics. Although the rate of pregnancies after hysteroscopic metroplasty is almost equal to those of metroplasty perfomed using laparotomy, a lot of advantages are for endoscopic operation. Hysteroscopic metroplasty is the present treatment of choise for management of the uterine septum, the remaking of the morphology of the uterine cavity using usually everytime when this congenital malformation is discovered at a pacient who is examined for infertility.
Keywords: septate uterus, bicornuate uterus, hysterosalpingogram, metroplasty