Müllerian duct anomalies: A retrospective case series focussing on outcomes in patients with a uterine septum

Objective: The impact of the various (sub)classes of Müllerian anomalies on reproductive and obstetric outcomes remains unclear. Accurate diagnosis of these anomalies is also challenging due to the use of different diagnostic methods and classification systems. Furthermore, the benefits of hysteroscopic septum resection are still debated. This study aimed to describe reproductive and obstetric outcomes in patients with Müllerian anomalies, specifically uterine septa, with a focus on outcomes before and after hysteroscopic septum resection. Material and methods: Patients aged ≤45 years with a Müllerian anomaly diagnosed or treated at Ghent University Hospital between 2000–2020 were retrospectively included. Anomalies were classified using the ESHRE/ESGE system. Results: 134 patients were included, of which 50.0% reported subfertility. The most frequent diagnosis was a partial uterine septum (n = 56, 41.8%). Seventy patients underwent hysteroscopic septum resection. The proportion of patients with live births was 60.0% higher after septum resection (95% CI 45.0–71.0 %, p < .001), whereas the proportion of patients with pregnancy loss <12 weeks was 40.0% (95%CI 17.2–57.1 %, p = .001) lower after septum resection. A subgroup analysis among patients who had been pregnant both before and after septum resection confirmed these results. In those patients (n = 31), obstetric complications were reported in 70.0% of ongoing pregnancies before and 37.8% after surgery. Discussion: Our findings confirm the higher risk of adverse reproductive outcomes in patients with uterine septa. Hysteroscopic septum resection was associated with more live births and fewer early pregnancy losses. No severe complications were observed.