Uterine septum and reproductive outcome. From diagnosis to treatment. How, why, when?

BACKGROUND: Septate uterus is a benign congenital malformation and represents the most common uterine anomaly in women with poor reproductive outcome. OBJECTIVES: To review the available scientific data concerning the biological context of the intrauterine septum and the association with poor reproductive outcome, the best methods for diagnosis and treatment. MATERIALS AND METHODS: From July 2020 to October 2020, we searched for relevant free full text articles in PubMed, written in English, and published from the 1st of January 2000 to 31st of July 2020. MAIN OUTCOME MEASURES: Association of the pathophysiology of septate uterus with poor reproductive outcome, evaluation of the different classification systems, the accuracy of diagnostic methods and the efficacy of the available treatment options. RESULTS: 259 articles were screened, and 22 articles were finally included in our study. Many theories regarding the pathophysiology of this congenital anomaly and its’ association with reproductive problems have been proposed along the recent decades. Combination of diagnostic methods should be used to avoid misclassification of this congenital anomaly. CONCLUSIONS: Lack of uniformity in the different classification systems makes the diagnosis of septate uterus challenging as there is no universally accepted definition. Data regarding the reproductive outcome of women with septate uterus are still limited, thus recommendations regarding optimal treatment of these women are biased. WHAT IS NEW? According to new insights regarding the pathophysiology of the uterine septum, differences in the underlying embryological defects are associated with changes in the histological composition and vascularisation of septa, as well as in clinical significance.