Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes-A Systematic Review and Meta-Analysis of Observational Research.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 35743362 · doi:10.3390/jcm11123290
What was done
A systematic review and meta-analysis of observational studies searched Medline, Scopus, Embase, and ScienceDirect to evaluate the reproductive and obstetrical effects of uterine septum and hysteroscopic metroplasty in patients with infertility or recurrent miscarriage. Three comparative frameworks were assessed using odds ratios (OR) and 95% confidence intervals (CI): (1) untreated uterine septum versus no septum controls, (2) treated versus untreated septum, and (3) before versus after septum resection. Evaluated outcomes were pregnancy rate (PR), live birth rate (LBR), spontaneous abortion (SA), and preterm labor (PL).
What was found
Thirty-eight studies were included: - **Septum vs. no septum:** Uterine septum was associated with significantly lower PR (OR 0.45, 95% CI 0.27–0.76; p < 0.0001) and LBR (OR 0.21, 95% CI 0.12–0.39; p < 0.0001), alongside higher SA (OR 4.29, 95% CI 2.90–6.36; p < 0.0001) and PL (OR 2.56, 95% CI 1.52–4.31; p = 0.0004). - **Treated vs. untreated septum:** Resection was associated with reduced SA (OR 0.47, 95% CI 0.21–1.04; p = 0.001), but showed no significant difference in PR (OR 1.10, 95% CI 0.49–2.49; p = 0.82) or PL (OR 0.81, 95% CI 0.35–1.86; p = 0.62). - **Before vs. after resection:** Removal was associated with marked increases in LBR (OR 49.58, 95% CI 29.93–82.13; p < 0.0001) and reductions in SA (OR 0.02, 95% CI 0.02–0.04; p < 0.000) and PL (OR 0.05, 95% CI 0.03–0.08; p < 0.0001).
Why it matters
This review compiles observational evidence supporting the link between uterine septa and impaired reproductive outcomes, suggesting hysteroscopic resection may reduce miscarriage risk.
Limits
All included data derive exclusively from observational studies, introducing substantial risk of selection bias, unmeasured confounding, and reporting bias. Before-and-after comparisons are highly vulnerable to regression to the mean and survivor bias, producing extreme effect sizes. A reporting inconsistency exists in the abstract regarding the treated versus untreated SA outcome (reported 95% CI 0.21–1.04 crosses 1.0 despite a reported p = 0.001). Total patient sample size is not reported in the abstract.
Cited by
- supports A uterine septum causes recurrent miscarriages and infertility.