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The objective of this study was to ascertain if incomplete correction leaving a residual uterine septum of < or = 1 cm affects fertility outcome. Reproductive outcome in 17 women with a residual septum of between 0.5 cm and 1 cm after hysteroscopic metroplasty was compared to that in 51 women with no residual septum or one of < 0.5 cm. Septal lysis was performed with microscissors or resectoscope. One month after operative hysteroscopy, abdominal ultrasonography was performed on all the women and those with a residual septum of > 1 cm then underwent a second operative hysteroscopy to complete the lysis. The cumulative pregnancy and birth rates were calculated and the curves compared using the log-rank test. The cumulative 18 month probability of becoming pregnant was 44.5% in the patients with residual septum and 52.7% in those with no residual septum (not significantly different), and the cumulative 18 month probability of giving birth to a child was 27.5 and 36% respectively (also not significant). The presence of a residual uterine septum of between 0.5 and 1 cm as shown by ultrasonography appears not to worsen the reproductive prognosis compared with that in women in whom the septum has been completely or almost completely corrected.

Our results indicate the need to suspect a urinary tract anomaly, particularly of the kidney, in all women with a unicornuate uterus.

Frequency of recurrence of fibroids after myomectomy has been evaluated in 145 women (median age 38 years, range 21-52) who underwent myomectomy. After surgery all women returned for follow-up visit every 12 months after surgery. Transvaginal ultrasound examination was performed routinely in every patient at 24 and 60 months and at 12, 36 and 48 months if there were any abnormal pelvic findings or suspicious symptomatology. A total of 39 (27%) women gave birth after myomectomy. For the whole series, the cumulative probability of recurrence (CPR) increased constantly during the study period reaching 51% in 5 years. The 5-year CPR decreased with parity after myomectomy, being 55% for women with no childbirth after surgery and 42% (based on 13 recurrences, P < 0.01) for those who gave birth.

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