Uterine septum is the most common congenital anomaly of the uterus. In some circumstances it might increase the risk of pregnancy loss.
Many patients are unaware of this condition until they enter childbearing age. The uterine septum might go completely unnoticed until it affects the early pregnancy.
What causes it?
The human uterus consists of a cavity that is surrounded by muscle and vasculature. In some other animals, for example in a mouse, the uterus consists of two completely separated tubular structures. Each of them can carry multiple embryos. The human uterus was also formed from two separate tubes. These are supposed to fuse together before birth. However, some females are born with a uterus that has not completely fused together.
Who picks it up?
It is very unlikely that this condition will be picked up anytime prior to visiting a fertility specialist. Most of the patients will not have any symptoms or any other problems associated with the uterine septum. This might change when trying to become pregnant.
Most of the patients do not have a need for a transvaginal ultrasound. Among the patients who for some reason need to have a transvaginal ultrasound, very few actually get diagnosed with a uterine septum. The reason is that the shape and form of the uterus might not be clearly appreciated during a routine scan, since it is very easy to miss it on a 2-D ultrasound.
How do you diagnose it?
Most of the uterine septi are diagnosed by fertility subspecialists, after the patient presents with recurrent pregnancy loss. Some clinics report that 20 to 30% of their patients have more or less evidence of a septate uterus. A skilled ultrasonographer can diagnose the septum on a regular two dimensional (2-D) ultrasound by sweeping the probe from side to side. However a 3-dimensional (3-D) ultrasound can give an unmatched view of the uterine shape, but not every clinic has it. Back in the day, the HSG (Hysterosalpingogramm) was the only method to diagnose the septum. However, this method utilizes radiation and can cause significant pain. The most extensive evaluation is performed with an MRI, however this is a very expensive procedure.
Partial septum vs. bicornuate uterus?
It is important that your fertility specialist makes the correct diagnosis of the uterine septum versus a bicornuate uters. The uterine septum contains a separation in the uterine cavity, however the outer appearance of the uterus is normal. A bicornuate uterus at the other hand has a completely separated upper end both internally and externally. Diagnosing this properly is very important since an attempted resection of the bicornuate uterus, that is improperly diagnosed as a uterine septum might create a uterine perforation. Therefore the 3-D ultrasound or an MRI is strongly advised prior to any corrective surgery. The old-fashioned way of diagnosing the uterine septum by a hysterosalpingogram (HSG) only yields information about the cavity but not about the outer shape of the uterus. Therefore it is very important for the patient to have the proper imaging in place prior to making any decisions.
How do we do it?
At the Tree of Life Center, we use a 3D vaginal ultrasound to determine the extent of the uterine anomaly and create a 3D picture of the uterine cavity. Our software allows us to then rotate the virtual image of the uterus in any dimension and clarify all issues. Surgical management in the form of a hysteroscopic removal is always recommended before attempting to get pregnant in cases of a very long and prominent uterine septum. In cases where the septum is very small and affects only the very top of the uterus, there might not be any need to perform surgery. The clinical history plays a very important role, since some patients can be affected by even a relatively small uterine septum.
The explanation of the detrimental effects is that the uterine septum lacks adequate blood supply and the embryo has a high risk of failure if it attempts to develop on the septum itself. Some very large uterine septi can affect the pregnancy at later stages and the baby may not be able to position itself before the birth with the head down.
At the tree of life Center we can offer an online consultation with Dr. Jovanovic and review the prior studies and provide you with a second opinion about your uterine septum. We also welcome to visit our clinic in Los Angeles and have a 3-D ultrasound performed to further evaluate your anomaly.
In the case that your uterine septum requires treatment, we will be happy to provide you with a complete package that includes a hysteroscopic resection in one of our surgery centers. This procedure can be completed in one day without any incisions. Special care needs to be taken to avoid going too far with the uterine septum resection and to avoid creating a hole at the top of the uterus. In some cases we utilize in ultrasound during surgery or perform a concomitant laparoscopy to evaluate the uterus after introducing a small camera through the belly button.
Please feel free to contact us if you have any questions!