Management of complete vagino-uterine septum in patients seeking fertility: Report of two cases and review of literature

Septate uterus is the most common congenital uterine anomaly encountered clinically. It is associated with infertility and adverse pregnancy outcomes including miscarriages and preterm births. Over the past few decades, the diagnosis and surgical management of uterine septum has changed significantly. Here, we present two women with complete vagino-uterine septum presenting with infertility. The diagnoses of septate uterus were made through three-dimensional ultrasound and magnetic resonance imaging, and they were treated with thin-gauge bipolar electrocautery (VERSAPOINT) through hysteroscopy. A literature review of the approach to managing complete vagino-uterine septum suggests the use of combinatorial imaging modalities such as hysterosalpingography, three-dimensional ultrasonography, and magnetic resonance imaging to accurately define the anatomy. Furthermore, compared with open surgery, treatment through hysteroscopic approaches are associated with shorter operating times and good fertility outcomes. With the use of concomitant laparoscopic and ultrasound monitoring, the incidence of uterine perforation and visceral injury may be reduced. However, referral to a center with such expertise is essential.