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The uterine septum is a congenital anomaly that makes it harder for your embryo to implant successfully. However, you can improve your fertility outcomes by understanding this condition, diagnosis and treatment options.
What Is a Uterine Septum?
A uterine septum is an anatomical defect in which muscular tissue or fibrous growth divides the uterine cavity either partially or completely. This condition is present at birth because it forms during foetal development when the two Müllerian ducts fail to fuse completely. Hence, a wall or septum divides the uterus instead of forming a single cavity.You may not have any obvious symptoms and may even be unaware of it. It is usually diagnosed during reproductive assessments. However, it hugely impacts your fertility, especially during implantation.
Understanding Repeated Implantation Failure (RIF)
It is equally important to understand what repeated implantation failure means before you learn about the impact of the uterine septum on fertility.RIF is typically defined as the failure to achieve a clinical pregnancy after the transfer of good-quality embryos. At least three embryo transfers or the placement of 4 or more high-quality embryos across cycles is required to conclude it.
While many factors may contribute to RIF, ranging from endometrial issues to immune dysfunctions, your physical uterine health is a key factor to consider.
How a Uterine Septum Affects Embryo Implantation
You may wonder how a small internal partition can have such a big impact on embryo implantation. It is primarily due to the uterine environment it creates and the presence of surrounding tissues.A normal uterine lining is rich in vascular tissues that respond well to your hormonal releases. It creates an ideal uterine environment for your embryo to implant and grow. However, a uterine septum is often highly fibrous and less vascular, which can affect your embryo's implantation.
Here's how this can affect your fertility:
- Embryo Misplacement: If an embryo implants on the septum, it may not receive a sufficient blood supply to thrive.
- Distorted Cavity: The shape of the uterine cavity becomes abnormal, potentially affecting the positioning and successful implantation of embryos.
- Altered Uterine Contractility: Some studies suggest that a septate uterus may have abnormal patterns of uterine contractions, which could interfere with embryo implantation and its stability.
Diagnosing a Uterine Septum
If you are undergoing fertility treatment and experiencing RIF, your doctor may recommend a detailed evaluation of your uterine anatomy. Several diagnostic tools are used to determine the presence of a uterine septum.- Transvaginal Ultrasound (2D or 3D): A basic imaging test that can offer initial clues, but it is not definitive.
- Hysterosalpingography (HSG): This X-ray test outlines the inside of your uterus and fallopian tubes. It can suggest the presence of a septum but may not distinguish it from similar anomalies, such as a bicornuate uterus.
- Sonohysterography (Saline Infusion Sonography): Injecting saline into the uterine cavity during ultrasound provides clearer visualisation of internal contours.
- MRI (Magnetic Resonance Imaging): It is useful in distinguishing a uterine septum from other uterine anomalies.
- Hysteroscopy: It is a minimally invasive procedure that allows direct visualisation and, if necessary, treatment in the same session. It is often the best option for both diagnosis and treatment.
Your doctor may use a combination of these methods for a precise diagnosis.
Treatment: Can a Uterine Septum Be Corrected?
Fortunately, a uterine septum is treatable, and its treatment can significantly improve your chances of a successful pregnancy.Your doctor may suggest a hysteroscopic metroplasty, which is a minimally invasive surgical procedure. It involves removing the septum and removing it using a hysteroscope. It has the following benefits.
- It preserves your uterus
- It typically requires no incisions
- Recovery is relatively fast
- It significantly improves the implantation rate and pregnancy outcomes
Multiple studies have shown an increase in implantation rates and live birth rates after surgical removal of the septum.
What to Expect After Surgery
If you have a hysteroscopic septum removal procedure scheduled with your doctor, you can expect the following.- Recovery Time: Most people return to normal activities within a few days.
- Hormonal Treatment: Your doctor may prescribe oestrogen therapy post-surgery to help regenerate the endometrial lining.
- Follow-up Imaging: A follow-up hysteroscopy or sonohysterogram may be performed to ensure complete correction of the issue.
- Timing for Conception: Generally, you will be advised to wait at least one cycle before resuming fertility treatments or trying to conceive naturally.
The surgery significantly increases the chances of conception. Even with RIF experience, you can conceive and carry your pregnancy to term.
When Should You Suspect a Uterine Septum?
Although a uterine septum is a condition present at birth, you may be unaware of it until you face fertility challenges. Consider discussing the following aspects with your doctor about a uterine septum.- Repeated implantation failures despite high-quality embryos
- Experienced multiple early miscarriages
- Uterine anomaly as per your ultrasound or HSG results
Emotional Considerations
Repeated implantation failure often takes a toll on your overall health. Determining an underlying cause, like a uterine septum, is both a relief and a challenge. Despite the explanation, you may still feel anxious about the next steps, which could further delay pregnancy.The important aspect is to stay informed and take appropriate steps after discussing them with your doctor.
As someone going through the fertility process, you must explore every possible cause of repeated implantation failure. A uterine septum might not be visible to the naked eye or through symptoms, but its impact on implantation can be profound.
With correct diagnosis and treatment, you can improve your chances of a successful pregnancy. You can discuss the possibility of a uterine anomaly with your fertility specialist. A conception journey is often difficult, but staying informed about your conditions is necessary. It empowers you to make informed decisions about your reproductive health.
FAQs on Uterine Septum and Its Role in Repeated Implantation Failure
- Is a uterine septum the same as a bicornuate uterus?
Both are congenital uterine anomalies with different reasons for their formation. The incomplete absorption of tissue between the Müllerian ducts leads to the formation of a uterine septum. A bicornuate uterus is due to incomplete fusion of these ducts. An MRI or a 3D ultrasound is required for accurate diagnosis. - Can I conceive naturally after uterine septum surgery?
Yes, you can conceive naturally after a successful hysteroscopic resection of a uterine septum. Your doctor may assess your overall fertility profile and suggest assisted reproductive technologies. - Is hysteroscopic surgery for a uterine septum safe?
Generally, hysteroscopic metroplasty is a safe and minimally invasive procedure. The chances of complications are very rare, and recovery is quick. Your doctor may discuss the risk factors related to your reproductive health.