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Reprod Biomed Online. 2018 Dec;37(6):709-715. doi: 10.1016/j.rbmo.2018.09.013. Epub 2018 Oct 22.

Hysteroscopic septum resection and reproductive medicine: A SWOT analysis.

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Hospital del Mar-Parc de Salut Mar, Paseo Maritimo 25-29, Barcelona 08005, Spain. Electronic address:
Instituto Valenciano de Infertilidad, Plaza de la Policía Local, 3, Valencia 46015, Spain.
Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret 167, Barcelona 08025, Spain.
Institut Clinic Obstetrics, Gynecology and Neonatology (ICGON). Hospital Clinic, C/Villarroel 160, Barcelona 08036, Spain.
Hospital Universitario Virgen de las Nieves, Avd Fuerzas Armadas s/n, Granada 18014, Spain.
Instituto Valenciano de Infertilidad, Avda, del Talgo 68, Madrid 28023, Spain.


Hysteroscopic septum resection in women with unfavourable reproductive and clinical outcomes has become common practice worldwide to improve reproductive results. No clear evidence on the possible advantages and drawbacks of this procedure has been published. In this opinion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of this strategy are evaluated. Currently, no level 1 published evidence supports uterine resection in women with septate uterus. Clinical evidence from the studies analysed matches the more recent guidelines and suggests an improvement in reproductive outcomes after hysteroscopic resection of the septum, particularly in infertile women and women who have experienced recurrent miscarriages. In a patient with no history of infertility or prior pregnancy loss, it may be reasonable to consider septum incision after counselling about the potential risks and benefits of the procedure. Published clinical data in favour of the intervention, however, are based on studies with important methodological limitations. In this situation, the clinician and patient should reach an agreement together, based on the pros and cons of this intervention. Well-designed randomized controlled trials are required to confirm the clinical benefits and cost-effectiveness of this procedure.


Infertility; Metroplasty; Preterm delivery; Recurrent miscarriage; Septate uterus; Septum resection; Spontaneous abortion


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