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Congenital Anomalies of the Uterus: septum

Congenital Anomalies of the Uterus: septum

Congenital Anomalies of the Uterus: septum

Congenital Anomalies of the Uterus: septum: A uterine septum is a vertical separation in the middle of the uterus dividing the cavity into two: right and left. The septum may be partial or could extend all the way through the cervix or even to a varying distance into the vagina.

Uterine Septum and congenital uterine anomalies

Uterine Septum and congenital uterine anomalies

Many of these separations are unnoticed. Septa may be discovered accidentally e.g during a hysterosalpingogram (HSG) done to investigate infertility. The role of a reproductive endocrinologist is to a. confirm the diagnosis of a septum and differentiate it from other conditions that make the uterus appear as double; bicornuate uterus and uterus didelphys and b. to counsel the couple about the possible effects of the septum on reproduction and indication for corrective surgery of the uterus

Diagnosis of Uterine Spetum

After clinical exam to inspect the cervix, HSG can visualize the duplication of the uterus but cannot accurately differentiate a septum from two separate uterine horns. MRI and 3D ultrasound can accurately characterize the abnormality.

Effects of Uterine Septum on Reproduction

A septum is not a proven cause for infertility. In fact the majority of women with uterine septum are without symptoms. Some women with a septum manifest with recurrent first trimester pregnancy loss or less commonly late (second trimester) pregnancy loss and preterm labor.

It is unpredictable who will carry a pregnancy to term and who will have a pregnancy loss. Because the outcome cannot be predicted, the majority of reproductive endocrinologists

recommend resection of the septum to unify the uterine cavity. This is especially the case after this

Hysteroscopic Resection of Uterine Septum Completed

Hysteroscopic Resection of Uterine Septum Completed

surgery can be accomplished with minimal access hysteroscopic surgery. An operative hysteroscope is introduced into the uterus and a micro scissors or an electric loop is used to cut the septum.

There is some evidence that resection of a septum may reduce the chance for pregnancy loss.

 

Accurate diagnosis of uterine septum is essential before discussing the possible reproductive consequences and method of correction.

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Should you Test Embryos created after IVF if You had Recurrent Miscarriage?

Should you Test Embryos created after IVF if You had Recurrent Miscarriage?

PGD Recurrent Miscarriage

1. Early pregnancy loss approximately < 10 weeks, mainly due to chromosomal abnormalities of the embryo and

2. Late pregnancy loss ≥ 10 weeks due to structural uterine abnormalities, hormonal factors, blood clotting abnormalities, immunological factors and chromosomal abnormalities of the embryos (less likely than early loss).

Women with history of recurrent miscarriages should be tested for all these factors before a fertility treatment plan is finalized.

Factors that point to chromosomal abnormalities as a cause for recurrent miscarriage

  1. Advanced maternal age,
  2. Diminished ovarian reserve (e.g high FSH, low AMH),
  3. Early pregnancy loss before a fetal heart activity is detected (chemical pregnancy, blighted ovum),
  4. Abnormal chromosomes of the products of conception and
  5. Abnormal chromosome configuration of male or female partner e.g chromosome translocation. Less than 5% of couples miscarry due to a translocation in the male or female partner.

Structural abnormalities of the uterus are detected using saline sonography, hysteroscopy or MRI scan. Blood tests can detect hormonal abnormalities, clotting abnormalities and immunological factors.

Should you Test Embryos created after IVF if You had Recurrent Miscarriage? (if chromosomal abnormalities of the embryos are suspected)

Factors to consider before deciding to test embryos:

  1. Embryos should probably be tested in women or men that carry abnormal chromosome configuration e.g. translocation as they produce higher proportion of abnormal embryos than parents of the same age
  2. Embryos should be tested if avoiding another miscarriage  is a priority, especially if prior miscarriages took place later in the first trimester and required surgery. Repeated scrapping of the uterus can damage the lining that may be difficult to treat (Asherman syndrome).
  3. There is no prove that PGD for chromosomes will improve the chance for conceiving a normal child. PGD will only detect what you have and is not a therapeutic procedure. The decision for embryo testing using PGD should be individualized for all other parents. Older women may not have any normal embryos to transfer after testing. Although testing may avoid a pregnancy with an abnormal embryo that implant and survive >10 weeks, the majority of abnormal embryos do not implant or are miscarried extremely early.

Just because it is available, sounds plausible and you have the means to do it, does not mean you should test your embryos prior to IVF.

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