DEPARTMENT OF OBSTETRICS AND GYNECOLOGY DIVISION OF REPRODUCTIVE ENDOCRINOLOGY & University of Wisconsin School of Medicine and Public Health

Dan I. Lebovic, MD, MA Uterine Septum Associate Professor and Division Chief Division of Reproductive Endocrinology & Infertility 1. Do you know what my septum to length ratio is? If not, should that be University of Wisconsin determined prior to surgery? Clinical Science Center 600 Highland Avenue The approximate septum to uterus length ratio can be calculated. Currently the Madison, WI 53792-3236 recommended surgical case is when the septum occupies at least ~30% of the cavity up 608/265-0300 appointments to the internal portion of the . 608/262-7111 fax [email protected] 2. Is there any way my septum could be mistaken for an acurate? If the MRI did not see a fiberous portion and it's only 9 mm long, could that be mistaken for a septum? A subtle septum is actually an , it is a very fine distinction and, in fact, the two are synonymous. If, however, the septum extends further (subject to MRI analysis) towards the cervix it takes on the name of "septum" as opposed to "arcuate." I would consider yours as a septum.

3. Is my septum made of fibromuscular tissue? The septum has often been thought to be strictly non‐muscular—more fibrous. However, when portions of septa have been analyzed under the microscope uterine muscle tissue has been found. Surgery is appropriate for fibrous AND fibromuscular tissue.

4. I’ve read that there are different opinions as to whether a septate uterus hinders implantation/fertility. Do you believe that this is why I’ve had difficulty with implantation? The issue of whether of not a septum leads to more is controversial. From several studies it does appear as though a septum is more common in those with multiple miscarriages. What has never been studied in a controlled randomized fashion is if removing the septum actually changes the outcome. That is our belief but it is not based on any well done study to date.

5. Do I need my renal system evaluated through a renal ultrasound, MRI or IVP? Are there other difficulties/disorders associated with this anomaly? Having a uterine septum is NOT associated with renal anomalies, no special testing is necessary for women found to have a uterine septum. There may be an increased risk of having endometriosis if one has a septum and do tend to have a greater incidence of preterm labor for those with a uterine septum. Other than that there is no other disorder associated with this anomaly.

6. Do you believe in hormone treatment before and after surgery? Hormonal therapy such as oral contraceptives may be used before surgery. On the day of surgery we do prescribe two hormones to be taken: (i) Premarin (2.5 mg days 1‐25) (ii) Provera (10 mg/day) or Prometrium (200 mg twice a day) from days 16‐25

7. Do you do the surgeries with a concurrent laparoscopy or ultrasound? We have used both but I prefer concurrent laparoscopy to better assess your abdomen and pelvis as well as help guide the dissection of the septum.

8. Do you believe in giving a one month post‐operative HSG? My preference is indeed to assess the cavity post‐operatively (one month later) in the office with a flexible office hysteroscope in order to break‐up any fine, thin adhesions that may have formed.

9. How long after surgery can I start trying to conceive again? As soon as you have your next period it would be reasonable to try to conceive.

10. Can I expect difficulties/risks during pregnancy after a septum removal? None known.

11. What is recovery like? The usual post‐laparoscopy and recovery is expected, namely a few days of convalescence but mostly a rapid return to normal except for the intra‐uterine catheter/balloon used to keep the uterus from developing any adhesions. This catheter is kept in place for around 5 days after surgery.

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