Corroenne R, Legendre G, May-Panloup P, El Hachem H, Dreux C, Jeanneteau P, Boucret L, Ferré-L'Hotellier V, Descamps P, Bouet P-E
Department of Reproductive Medicine, Angers University Hospital, 4, rue Larrey, 49000 Angers, France.
Department of Reproductive Medicine, Angers University Hospital, 4, rue Larrey, 49000 Angers, France.
J Gynecol Obstet Hum Reprod. 2018 Nov;47(9):413-418. doi: 10.1016/j.jogoh.2018.08.005. Epub 2018 Aug 24.
Septate uterus is the most common congenital uterine malformation in women with infertility. Several criteria are available for the definition of septate uteri, such as the one proposed by the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynecological Endoscopy (ESGE) (ESHRE/ESGE), or by the American Society for Reproductive Medicine (ASRM), with notable differences between the two. Recently, a simplified classification was proposed by the Congenital Uterine Malformations Experts (CUME), where a septum is defined as an internal indentation depth≥10mm. To date, there is no consensus on the management of women with a septate uterus and infertility. We have performed an extensive literature appraisal and reviewed all the available international guidelines in order to propose a management strategy for infertile patients with a uterine septum. Hysteroscopic septum incision seems to improve natural conception rates in the year following surgery. Moreover, it improves in vitro fertilization (IVF) outcomes when performed before the embryo transfer, by improving embryo implantation rates. On the other hand, for patients with an arcuate uterus (indentation<1.5cm according to the ASRM guidelines) and infertility, it seems that assisted reproductive technologies are the most appropriate first line treatment. However, in cases of recurrent implantation failure or recurrent pregnancy loss following IVF, hysteroscopic section could be proposed. Overall, we recommend hysteroscopic septum incision for patients with primary infertility, and for patients undergoing assisted reproductive technologies.
纵隔子宫是不孕女性中最常见的先天性子宫畸形。有多种标准可用于定义纵隔子宫，比如欧洲人类生殖与胚胎学会（ESHRE）/欧洲妇科内镜学会（ESGE）（ESHRE/ESGE）提出的标准，或者美国生殖医学学会（ASRM）提出的标准，两者存在显著差异。最近，先天性子宫畸形专家（CUME）提出了一种简化分类方法，将纵隔定义为内部凹陷深度≥10mm。迄今为止，对于纵隔子宫合并不孕的女性的治疗尚无共识。我们进行了广泛的文献评估，并查阅了所有可用的国际指南，以便为患有子宫纵隔的不孕患者提出一种治疗策略。宫腔镜纵隔切开术似乎能提高术后一年内的自然受孕率。此外，在胚胎移植前进行该手术，通过提高胚胎着床率，还能改善体外受精（IVF）的结局。另一方面，对于弓形子宫（根据ASRM指南，凹陷<1.5cm）合并不孕的患者，辅助生殖技术似乎是最合适的一线治疗方法。然而，对于IVF后反复种植失败或反复流产的病例，可以考虑宫腔镜切开术。总体而言，我们建议对原发性不孕患者以及接受辅助生殖技术的患者进行宫腔镜纵隔切开术。
