Septate Uterus

In 2021, The American Society of Reproductive Medicine (ASRM) updated its Müllerian Anomaly Classification System (MAC2021) to update and expand prior classification systems in a manner that applies to all levels of healthcare providers and promotes patient awareness and advocacy. MAC2021 classifies Müllerian anomalies into 9 categories: Müllerian agenesis, cervical agenesis, unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, longitudinal vaginal septum, transverse vaginal septum, and complex anomalies.  The septate uterus is the most commonly encountered Müllerian anomaly. ASRM defines a septate uterus with an indentation depth of >15 mm and an indentation angle of <90°. In contrast, The European Society of Human Reproduction and Embryology (ESHRE) defines a septate uterus using indentation-to-wall-thickness (I:WT) >50%, and the Congenital Uterine Malformation by Experts (CUME) suggest using an indentation depth of ≥1 cm.  Clinical determination of the need for surgical intervention for a septate uterus is challenging and controversial due to these varying yet accepted definitions.