Removing uterine septate for infertility?

[boston_couple]

So, I posted on Friday, after my wife and I got a BFN following a 2nd IVF. I'm 38, she's 36, and we have unexplained fertility. All our "numbers" look great, embryos have been very good, and we still have 3 frozen.

So, the doc called back at 5 the day I posted. Said she has been conferring with the other docs, and they recommend removing the septate since everything else looks favorable, yet we are not getting pregnant.

Did some research on my own, though, and I am not finding much that indicates infertility is helped by removing a septate in a case like ours. Seems it is mostly about MC and carrying to term, not implantation. There is some research that says it helps. So we're confused.

Her septate is not major, and they knew about it a year ago when we started two unsuccessful IUIs prior to the 2 IVFs. At that time, they said it would not be a factor.

Any advice?

[BC-Maura]

Hi there: I had a mild uterine septum and had it removed and after it was removed, had no further problems conceiving (over a three-year period, I had had an early m/c, a molar pg, a long dry spell of not conceiving at all, and then another early m/c).

I was told by the RE who finally recognized that I had a septum that it can cause problems both with early m/cs and implantation because the septum offers very poor blood supply to a growing pg. So, whether it's a failure to implant at all or a failure to grow properly even though technically implanted, it amounts to the same thing really.

I would definitely go ahead and have it removed. My RE went in to do a hysteroscopy (because he said he couldn't tell for sure from my HSG and lap whether he thought it was enough of a problem (it was mild) and when he got it, he decided it was sufficiently possibly problematic, so he removed it. He then gave me high levels of estrogen to build up my lining to prevent scarring and adhesions, followed by progesterone. After that, he said to just start trying naturally again. Within 3 months after the surgery, I conceived my ds. And then when we were ready to start ttc #2, I conceived my dd within 3 months of starting that round of ttc!

I am in the Boston area, too, btw and would be happy to PM you the name of my RE!

Good luck to you and I'll wait to hear from you+++++++
Maura

[boston_couple]

Wow, thanks Maura. Will PM you.

[CdnMom]

I as well had bicornuate uterus with septum. My septum was surgically removed (hysteroscopy)and 2 months later on estrogen to help heal, we were pg on our own. My re also mentioned it's more to do with blood flow. I know my septum was at the top of my uterus making my uterus bicorunate(heart shaped) and which meant less blood flow to the top of the uterus. My re also said 90% or so of implation happens on the top of the uterus(that was 8 years ago not sure how the numbers are now). Defintely have it removed and fingers crossed it will the help you need.

[BC-Maura]

Michelle: My RE said the same thing -- that most pgs implant near the top and if that's where the septum is, it can definitely decrease the chances of a pg landing in a spot with sufficient blood supply. In my case, my uterus was arcuate -- the outside looked normal, but the inside was heart-shaped.

Best to you++++++++++++
Maura

[boston_couple]

Well, we met with the doc yesterday, and she is definately recommending the septate removal--unanimous among all 3 docs. (My wife's is a small fundal septum--I think near the top.) This means we would not be able to do the next FET until late Nov/early December. They are of course not 100% sure this is the cause. So they are willing to let us proceed with an FET if we so choose, next cycle (around 4 weeks)--which means transfer early October.

This is a very hard call, and my wife is very upset to have to wait as our last IVF took 4 months (April to August) to finally take place. She is leaning towards doing the transfer in Oct. and then having us reevaluate the septum if it fails. As she's 36, she feels every month is crucial, which I understand. I told her I'd support either decision. She is not happy with the doctor, but I do think the doc is doing what she feels is clinically right. At the same time, they are not changing up our protocol much--she said with a frozen transfer there is not too much to vary. As we have 3 frozen embies, I am leaning towards asking to put all 3 in as we may be having implantation issues...

My fallback plan is to book a different clinic for mid-October assuming we get a negative, so we can try someplace else. Argh.

[BC-Maura]

Hi there: I tried to PM you just now, but your mailbox is full! If you can delete some messages, I will resend.

Best+++++++++++++++
Maura

[boston_couple]

Cleaned up! Didn't notice it was limited to just 3.

[BC-Maura]

Ok, thanks!

+++++++++
Maura

[Cheryllynn]

I know how hard it is to be told to wait, but since the embryos on FET's they will still be there in two-three months.

I have several years of failed cycles and my 5th or 6th RE, I've lost count, thought he saw something suspicious on an u/s and wanted to do a hysteroscopy to rule out septums. He thought if he found one, it would be small. Much to his surprise, when he started the hysteroscopy, my uterine septum was very large and did not show on an u/s. He said he increased my uterine volume by 2 1/2 times.

My advice is to remove the septum and then continue treatments. I had to wait 2 months to have my surgery and then 2 more months waiting while healing.

My latest RE said that this septum could very well have caused so many years of failures, including failed cycles.

Plus, if do you get PG and the septum threatens the pregnancy, what are you going to do then? Does it seem right to finally get PG and then deal with a m/c and then wonder If Only ?

I think with a dx'd septum, after my years of heartache, I would definitely have that taken care of first.