Table 3.
General features of studies included in the meta-analysis: Before and after septum removal.
| Study | Design | Period | Population | Exclusion Criteria | Simple Size | Case | Outcomes | Follow-Up | Type of Hysteroscopic | Procedure/Metroplasty | Mode of Diagnosis | Method of Classification |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Valle et al., 1986, [41] |
Retrospective | N/A | Infertile Recurrent miscarriage Natural conception |
N/A | 124 | Women with uterine septum who underwent hysteroscopic metroplasty. | Spontaneous abortion Preterm labour |
N/A | N/A | N/A | N/A | N/A |
| Guarino et al., 1989, [42] |
Retrospective | N/A | Infertile Recurrent miscarriage Natural conception |
N/A | 19 | Women with uterine septum who underwent hysteroscopic metroplasty. | Spontaneous abortion Preterm labour |
six months | N/A | N/A | N/A | N/A |
| Choe et al., 1992, [43] | Retrospective | August 1986 to April 1990. | Infertile Recurrent miscarriage Natural conception |
N/A | 14 | Women with uterine septum who underwent hysteroscopic metroplasty. | Spontaneous abortion Preterm labour |
N/A | Nd-YAG laser with an 8-mm operating hysteroscope. | An incision was made from one cornua down the septum, then across the septum. Next, beginning at the opposite cornua, the same procedure was done until each tubal ostium could be seen in the panoramic hysteroscopic view. | Laparoscopy HSC |
N/A |
| Grimbizis et al., 1998, [44] |
Retrospective | January 1991 to Dec 1996. |
Infertile: Tubal factor Endometriosis Endocrinologic Male factor Idiopathic Recurrent miscarriage: two or more previous miscarriages ART conception: IVF or ICSI Natural conception |
N/A | 57 | Septate uterus Subseptate uterus |
Spontaneous abortion Preterm labour |
34 months | Rigid hysteroscope mounted with a rotatable 9 mm resectoscope. | Resection from the lower margin of the septum and continued upwards with progressive horizontal incisions in the midline until a normal cavity was obtained. | Laparoscopy HSC |
AFS (1988) criteria [5] |
| Jourdain et al., 1998, [45] |
Retrospective | 1990–1995. | Infertile Recurrent miscarriage: two or more spontaneous first trimester losses or be infertile. Natural conception |
N/A | 17 | Septate uterus | Live birth rate Spontaneous abortion |
41 months | Flexible hysteroscope with Nd-YAG laser. | The septum was divided by the laser after exploration of the cavity. | HSC | N/A |
| Porcu et al., 2000, [46] |
Retrospective | Feb 1988 to December 1996. | Recurrent miscarriage Natural conception |
N/A | 63 | Septate uterus | Live birth rate Spontaneous abortion Preterm labour |
48 months | 55 procedures performed with a 21-Fr resectoscope. Three procedures with endoscopic scissors. Five procedures with Nd-YAG laser. | Electric section performed in 55 cases (87.3%). Section with a pair of endoscopic scissors in three cases (4.8%). A Nd– Yag laser had been used in five cases (9.5%). The method to divide the septum was chosen on an arbitrary decision and not for a specific reason. | Hysterosalpingography TV-US | N/A |
| Venturoli et al., 2002, [47] |
Retrospective | January 1993 to December 1997. | Infertile: unexplained infertility of at least two years duration Recurrent miscarriage: two or more miscarriages in the last three years Natural conception ART conception |
No endocrine or other disorders. | 141 | Septate uterus | Live birth rate Spontaneous abortion |
36 ± 19.5 months | Rigid hysteroscope with a 26 gauge resectoscope (Karl Storz) | After visualization of the tubal ostia, the resection was started from the lower margin of the septum and continued upwards with a progressive horizontal incision in the midline. | Laparoscopy HSC |
AFS (1988) criteria [5] |
| Saygili-Yilmaz et al., 2003, [12] |
Retrospective | 1990–2000. | Infertile: primary infertility who failed to achieve pregnancy for over two years Recurrent miscarriage: two or more miscarriage Natural conception |
N/A | 361 | Septate uterus Subseptate uterus |
Live birth rate Spontaneous abortion Preterm labour |
36 months | Rigid hysteroscope with 26 gaude resectoscope and specific loop electrode (Karl Storz). | After visualization both of the tubal ostias, the incision of septa was started from the lower margin and continued upward with horizontal section until a normal cavity was obtained and both tubal ostia could be visualized. | Hysterosalpingography | AFS (1988) criteria [5] |
| Yang et al., 2006, [48] |
Retrospective | N/A | Infertile Recurrent miscarriage Natural conception |
N/A | 46 | Septate uterus Subseptate uterus |
Live birth rate Spontaneous abortion |
10.2 ± 1.3 months | Rigid hysteroscopy with operating channel into which an optic fiber can be inserted, connected with a Nd-YAG laser. | Incision of the septum between the anterior and posterior uterine walls extending up to the fundus rather into the fundal myometrium. | Laparoscopy HSC |
N/A |
| Wang et al., 2009, [49] | Prospective | Sep 2004 to Oct 2007 | Infertile: the inability to conceive after 12 months of unprotected intercourse Recurrent miscarriage: two or more previous spontaneous miscarriages Natural conception |
N/A | 25 | Septate uterus | Live birth rate Spontaneous abortion |
17.6 ± 5.4 months | 27-Fr hysteroresectoscope (Olympus, Hangzhou City, Japan) | The resection was performed between the anterior and posterior uterine walls, extending up to the fundus rather than into the fundal myometrium from the lower margin of the septum | 3D TV-US | AFS (1988) criteria [5] |
| Roy et al., 2011, [50] |
Retrospective | January 2000 to June 2008 |
Infertile Recurrent miscarriage Natural conception |
Presence of endocrine disease, uterine myoma, adnexal disease and abnormal semen parameters in the husband |
152 | Septate uterus Subseptate uterus |
Live birth rate Spontaneous abortion Preterm labour |
28 months | A 9-mm working element along with sheath and 4-mm 30° telescope (Karl Storz, Germany) equipped with a hysteroscopic monopolar (Collin’s) |
The septum was divided in a cephalad direction until both tubal ostia became clearly available. The resection of septa was stopped at the point when hysteroscope could be moved from one cornual end to another without intervening obstruction, and both tubal ostia could be viewed simultaneously |
HSC | AFS (1988) criteria [5] |
| Sendag et al., 2010, [51] |
Retrospective | N/A | Infertile Recurrent miscarriage Natural conception |
N/A | 30 | Septate uterus Subseptate uterus |
Spontaneous abortion Preterm labour |
N/A | N/A | N/A | N/A | N/A |
| Gergolet et al., 2012, [52] |
Prospective | January 2003 to December 2008. | Recurrent miscarriage: one or more miscarriages Natural conception |
Anovulatory cycles, polycystic ovary syndrome and those referred to assisted reproduction treatment. | 72 | Subseptate uterus | Live birth rate Spontaneous abortion |
N/A | 8-mm Karl Storzmonopolar operative hysteroscope | N/A | 2D/3D TV-US HSC |
AFS (1988) criteria [5] |
| Bendifallah et al., 2013, [53] |
Retrospective | January 1999 to December 2009. |
Infertile: primary infertility for >3 years as defined by inability to conceive. Recurrent miscarriage: at least two consecutive miscarriages before 16 weeks of gestation. Natural conception ART conception: IVF or ICSI |
N/A | 128 | Septate uterus | Live birth rate Spontaneous abortion |
38 months | Operative hysteroscope fitted with a monopolar hook (26F resectoscope, 2.9-mm optical lens; Karl Storz GmbH, Tuttlingen, Germany) |
the septum was incised equidistant between the anterior and posterior uterine walls, from the lower margin of the septum and continuing upward with progressive horizontal incisions in the midline to the uterine fundus. | HSC | AFS (1988) criteria [5] |
| Gundabattula et al., 2014, [54] |
Retrospective | 2003 to 2010. | Infertile: as the inability to conceive aft er 12 months of contraceptive-free intercourse Recurrent miscarriage: 3 or more pregnancy losses before 24 weeks’ gestation Natural conception |
N/A | 124 | Septate uterus Subseptate uterus |
Live birth rate Spontaneous abortion Preterm labour |
24 months | 26 FR resectoscope with a cutting monopolar electrode or a VersaPoint Hysteroscopy system with a spring-type electrode | The septum was divided in an upward direction until both tubal ostia were visualised in the same plane in a panoramic view of the uterine cavity. | TV-US. Hysterosalpingography | N/A |
| Paradisi et al., 2014, [55] |
Retrospective | January 2001 to June 2007. | Infertile Natural conception |
Oligo/anovulation and menstrual irregularities | 112 | Subseptate uterus | Live birth rate Spontaneous abortion Preterm labour |
N/A | Equatorial semicircular loop, cutting 0° with monopolar energy. | After visualization of the tubal ostia the resection was started from the lower margin of the septum and continued until the muscular component until a normal cavity was obtained and the hysteroscope could be moved freely from one tubal ostium to the other without any intervening obstruction. | HSC 3D TV-US |
AFS (1988) criteria [5] |
| John et al. 2015, [56] |
Retrospective | 2006 to 2014. |
Infertile Natural conception ART conception: IVF or ICSI |
N/A | 286 | Septate uterus Subseptate uterus |
Live birth rate Spontaneous abortion |
N/A | Monopolar cautery loop. | N/A | N/A | N/A |
| Freud et al., 2015, [57] |
Retrospective | 2004 to 2011. |
Recurrent miscarriage Natural conception ART conception: IVF or ICSI |
Multiple pregnancies were excluded from the analysis. |
28 | Septate uterus | Live birth rate Spontaneous abortion |
N/A | Bipolar versascope system (Gynecare, Johnson and Johnson, Somerville, NJ, USA) | Septum was divided until complete visualization of both tubal ostia at the same plane was achieved. | HSC 3D TV-US |
N/A |
| Wang et al., 2019, [58] | Retrospective | Jul 2006 to January 2017. | Infertile: defined as the inability to conceive for a minimal period of 1 year of trying to conceive Recurrent miscarriage Natural conception |
Pelvic lesions, such as endometriosisoligo or anovulation and menstrual irregularities; partners with abnormal semen analysis. | 121 | Septate uterus Subseptate uterus |
Live birth rate Spontaneous abortion |
12 | 7 mm rigid hysteroscope (Karl Storz). | Electrosurgical incision in the uterine septum was made equidistantly between the anterior and posterior uterine walls and went up high into the uterine fundus until the presence of a normal-shaped cavity was obtained. | Laparoscopy HSC |
AFS (1988) [5] and ASMR (2016) [6] criteria |
HSC: Hysteroscopy; TV-US: transvaginal-ultrasound.