Uterine Septum

Why Do I Need a Uterine Septum Resection?

Uterine septum resection is the only permanent fix for a septate uterus, which is a condition you’re born with. If you have this condition, a wall of tissue called a septum splits your uterine cavity into two smaller spaces instead of a single larger one. Your septum can be partial too, only partially separating your uterus. That wall has poor blood flow, so if an embryo lands there, it won’t get enough nutrients to survive.

Research shows a uterine septum is one of the most common structural causes of recurrent miscarriage. It shows up most often in women who have lost two or more pregnancies with no other explanation. Most women find out they have it only after a hysteroscopy for IVF and fertility fails or after losing more than one pregnancy.

A uterine septum resection can be treated through a minimally invasive hysteroscopy. Felix Cohen, MD, FACOG diagnoses and treats this condition at Hysteroscopy Center of New York in Midtown Manhattan, Columbus Circle and Queens. His hospital affiliations include Mount Sinai, NYU Langone and Lenox Hill.

“A septate uterus is one of the most treatable causes of recurrent miscarriage,” says Dr. Cohen. “Once we remove your septum, your uterus works the way it should.”

How Does a Uterine Septum Resection Help My Pregnancy and Fertility?

A uterine septum resection removes the wall inside your uterus that makes it hard or impossible to carry a pregnancy. Women who leave their septum untreated also deal with more cases of abnormal uterine bleeding and babies arriving too early. The pregnancy risks that make uterine septum resection necessary for you include:

• You’ve had two or more miscarriages before 20 weeks.
• Your baby arrived too early or was born smaller than normal.
• Your baby settled into a feet-first position instead of head-down before delivery.
• Your delivery needed a C-section because your uterus couldn’t support a normal birth.

These are among the risks Dr. Cohen looks for when he evaluates whether your symptoms point to a septum problem. Most women who struggle with these uterine abnormalities affecting fertility go on to have successful pregnancies once their uterus is corrected.

What Are the Symptoms That Lead to Septum Uterus Surgery?

Septum uterus surgery is recommended after a pattern of pregnancy failure. Most women with a septate uterus feel no pain. Your periods stay normal. Nothing points to the problem until a failed pregnancy does. The situations that lead Dr. Cohen to recommend septum uterus surgery for you include:

• Every other cause of your miscarriages has been ruled out, and your uterus hasn’t been checked yet for this genetic abnormality.
• Your IVF cycles keep failing even though your embryos are healthy and your hormones are normal.
• An ultrasound or MRI shows your uterus is split into two sections.
• You’ve been trying to conceive for over a year with no success and all other tests come back normal.

Your experienced NYC gynecologist looks directly inside your uterus with a small camera during a diagnostic office hysteroscopy. At Hysteroscopy Center of New York, your diagnosis and your surgery very often happen in the same visit with the see-and-treat method Dr. Cohen prefers.

What Does Uterine Septum Resection Involve?

Uterine septum resection is an outpatient procedure with no incisions and no hospital stay. Dr. Cohen performs it at his Midtown Manhattan office under the appropriate anesthesia and pain management. You’re in and out in about an hour. The steps involved in the procedure include:

• Placing a thin camera tube through your cervix, as your abdomen stays completely untouched
• Filling your uterus with a saltwater solution to gently open it up so the doctor can see clearly inside
• Cutting through the septum wall with small scissors or a tiny electric current until your uterus becomes one open space
• Checking that your uterus is fully open and the wall is completely gone

For a large or complex septum, Dr. Cohen splits the procedure into two visits. He also takes care of any other issues he finds during your procedure. This includes intrauterine adhesions, which is scar tissue inside your uterus or endometrial polyps. What you do in the first week after the procedure shapes your recovery.

How Long Is My Recovery After Septum Uterus Surgery?

Your recovery after septum uterus surgery is short. Most women return to their normal routines within two to three days. Follow your doctor’s recovery instructions, which include:

• Expect some light spotting and mild cramping in the first two days, which is completely normal
• Avoid strenuous exercise and heavy lifting for at least one week after your uterine septum resection
• Refrain from sex and tampon use until Dr. Cohen gives you the go-ahead at your follow-up visit
• Call Dr. Cohen’s team right away if you get a fever, bleed heavily or feel pain that’s not normal

Six weeks after your surgery, Dr. Cohen uses advanced hysteroscopy technology and equipment to check that your septum is gone and your uterus has healed. Per the American Society for Reproductive Medicine, you’re clear to begin fertility preservation or fertility treatment one to two months after your resection.

What Results Can I Expect After Uterine Septum Resection?

Uterine septum resection restores your uterus to a normal shape. IVF outcomes improve when your uterus is corrected before a transfer. Your risks of preterm birth, breech positioning and C-section delivery all decrease. The results you see after uterine septum resection include:

• Uterine septum resection removes the wall that stopped your embryo from attaching and growing.
• Your IVF transfer works better when your uterus is the correct shape.
• If Dr. Cohen finds fibroids or other structural issues during your evaluation, he takes care of those in the same procedure.

“The goal of this surgery is not just to remove tissue,” says Dr. Cohen. “It’s to give you a uterus that can carry a healthy pregnancy. That’s what every resection works toward: a viable pregnancy.”

Frequently Asked Questions (FAQs) about Uterine Septum