The place of hysteroscopic septoplasty in ART

Background
The aim of this study was to determine the reproductive outcomes after HS of septate uterus of women undergoing intrauterine insemination (IUI) or in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI).
Septate uterus is a malformation often found in women with poor reproductive history seeking assisted reproductive techniques (ART). This uterine anomaly can lead to infertility or recurrent pregnancy loss. Hysteroscopic septoplasty (HS) is a safe intervention to restore the uterine cavity surgically in such Mullerian anomalies.
Methods
This monocentric retrospective study included women with symptomatic septate uterus undergoing ART treatment after HS in our fertility centre.
Main outcomes were the pregnancy and first live birth rate after septoplasty. Further, the results were analysed depending on the need of IUI or FIV-ICSI.
Results
Thirty-six patients were identified with 3 lost to follow-up. The treatment has resulted in an overall pregnancy rate (PR) of 60% (20/33) and a cumulative pregnancy rate of 78% (26/33). The overall first live birth rate (LBR) is 39.4% (13/33) and the cumulative live birth rate is 48.4% (16/33). Eight patients out of the 33 used IUI resulting in 50% of pregnancies pregnancies (4/8)) and 25% of live births (2/8). For the women needing IVF/ICSI, the PR is 64% (25 patients with 16 pregnancies) and the LBR is 44% (11/25). It should also be noted that in 42% of the patients a male factor was involved in the infertility.
Conclusions
In our experience hysteroscopic septoplasty is a safe and effective procedure in patients presenting a symptomatic septate uterus prior to ART treatment. It might increase the reproductive outcome for both the IUI and the IVF/ICSI patients. However, the debate is still open whether to operate or not, pending prospective studies with more patients.