What changes after uterine septum surgery?

What does the evidence say about pregnancy after uterine septum surgery?

1. A septum is tissue dividing part of the uterine cavity. It must be distinguished from other uterine shapes because the recommended care differs. ASRM favors three-dimensional transvaginal ultrasound, with or without saline infusion, for evaluating the shape before decisions are made. 1
2. A hysteroscopic procedure reaches the cavity through the vagina and cervix. It is different from an abdominal operation on the outer uterus. Ask the surgeon to document the actual procedure, whether any complication occurred, and what follow-up is needed before pregnancy attempts. 2
3. ASRM notes that evidence for improved live birth after septum incision in infertility is uncertain, and recommends a shared decision-making discussion. Evidence and counseling differ when recurrent miscarriage is the reason for surgery. A successful-looking postoperative cavity cannot promise a particular pregnancy outcome. 1
4. A saline ultrasound can provide detail about the uterine cavity when clinically useful. It is not performed when pregnancy is possible. If postoperative imaging is requested, clarify its purpose, cycle timing, and pregnancy precautions before scheduling attempts to conceive. 3
5. Other contributors to difficulty conceiving can remain after a uterine procedure. Fertility evaluation may include ovulation, tubal assessment, and semen testing when applicable. Ask whether the septum finding explains the entire concern or whether another part of the evaluation still needs completion. 4
6. The guideline describes limited-quality evidence supporting a return to fertility care after one to two months in uncomplicated circumstances. It also notes that uterine rupture after septum surgery is rare and incompletely reported. Have the prenatal team review the operation rather than assuming every uterine procedure has identical birth implications. 1

What should you clarify after septum surgery?

• Before pregnancy attempts, confirm recovery and the surgeon's follow-up plan.
• When pregnant, share the operative report and reason for the original surgery.
• Discuss delivery planning using the actual operation and pregnancy findings.

Questions for your fertility or prenatal team