You are currently browsing the Dr Licciardi blog archives for February, 2007.

Last One About Septums

Thanks for hanging in there. This subject applies to very few of you, but the information is important to those who may be affected.
The reason it is vital to know your diagnosis has to do with treatment. If you have a septum, most (not all) doctors would recommend treatment. This is because an experienced reproductive surgeon can fix a septum relatively easily. It’s done through the vagina using a hysteroscope. The doctor looks in, then slides a tiny scissors through the scope and makes small cuts at the septum until it is gone, making the uterus normally shaped. Some doctors will recommend a laparoscopy at the same time to guide themselves through the surgery. Others will perform the surgery using the hysteroscope and an intra-operative ultrasound to guide them, avoiding the laparoscopy portion. In either case, patients go home the same day.
A bicornuate uterus is a whole different story. To fix this a doctor needs to perform a laparotomy (an incision into your abdomen), then slice the uterus wide open, then sew it up in such a way that the 2 sides come together to make one round uterus. As you can imagine, this has a much higher complication rate, and has a higher rate of infertility due to post-op scar tissue. Hospitalization can be 2-3 days. Full recovery is 6 weeks. Because this procedure is more difficult and has a higher complication rate, it is rarely performed.
This gets us back to the very beginning. If you have a septum, but your doctor calls it a bicornuate, you probably will not be offered treatment and be faced with continued increased odds of infertility and miscarriage. If the correct diagnosis of a septum is made originally, you could have a more simple procedure that may increase your odds of reaching your goal.
Many patients have come to me with a diagnosis of a bicornuate uterus. Told surgery was not a good option, they ask me what else can be done to help them get pregnant or reduce their odds of miscarriage. Some actually have a bicornuate uterus. Some are very surprised when I tell them they really have a septum and should revisit the surgical option.
I need to point out that septum repair does not guarantee fertility or a delivery, but for some patients it may be very helpful. As usual, please see disclaimer 5/17/06.

References:

  • Propst AM, Hill JA, 3rd. Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med 2000; 18:341-50.
  • Proctor JA, Haney AF. Recurrent first trimester pregnancy loss is associated with uterine septum but not with bicornuate uterus. Fertil Steril 2003; 80(5):1212-5.
  • Reichman D, Laufer M, Robinson B. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril 2009; 91:1886-1894.
  • Chervena, FA and Neuwirth, RS. Hysteroscopic resection of the uterine septum. Am J Obstet Gynecol. 1981; 39:560-3.
  • Hickok, LR. Hysteroscopic treatment of the uterine septum: a clinician experience. Am J Obstet Gynecol 2000; 182(6):1414-20.

It’s Been a Year

This blog started a year ago. I was talking to a friend of mine about ways I could “get the message out”. She asked me if I had a blog, I asked her “What’s a blog?” The same week I spoke to a patient who told me about her blog, so I got started.
This has been a very good year for me. I really like doing the blog. I get very excited about teaching people about themselves. Learning medicine was, and still is, a great joy for me. I find that when the information is presented correctly, most people are very interested in learning more about their bodies.
Unfortunately, some people are driven learn because things are not going their way. Failure, especially coupled with incorrect or conflicting information, pushes us to carefully assemble the details of our disease and treatment. My goal is to make it easier to see the facts through the hype.
The readership is growing. In 2006 there were 51,566 page loads and in January 2007 there were already 9,562. It’s great to see so many people involved. The American College of Obstetrics and Gynecology has recognized the value of medical blogs, and featured me the January issue of ACOG Today.
So thanks for reading along. The comments have all been great. Keep them coming.

ps. here is the text of the article, written by Marian Wiseman. Blogger doesn’t allow attachments, and it’s not possible to link to the article. Here is the plain text without the graphics.

For a year now, New York City infertility specialist and ACOG Fellow Frederick L.
Licciardi, MD, has been using a blog to help patients understand their infertility and various approaches to treatment.

his personal experience and perspectives, Dr. Licciardi’s blog gets about 6,000 hits a month
with entries such as “Is LH Important for IVF Success?” and “Uterine Scar Tissue after a D
and C.”

“I’m trying to give patients the ability to see through the sensationalism.”

Noting that reproductive medicine lends itself to the “selling” of new techniques, Dr.
Licciardi said, “I’m trying to give patients the ability to see through the sensationalism.
There are no quick fixes; there’s no magic bullet. People want to know ‘Is that something

that is really going to help me?’ Once they get the basic understanding they’ll be able to have
more control over their fertility care.”

Dr. Licciardi considers a blog a great way for physicians to communicate their message.

“The doctor can’t be afraid to let the patients know who she or he really is. It helps with the doctor-patient relationship.”

Blogs allow straight talk and create a community

Bicornuate or Septate?

I have added some pictures to help with the discussion. Take your time with them, if you are not used to looking at medical drawings or photos it takes a little while to get your bearings.
The first picture is a drawing of a normal uterus, no septum, not bicornuate. You can see the top of the uterus is slightly rounded, not indented. The inside is shaped like a triangle. The space inside the uterus is called the uterine cavity. The pink tissue surrounding the cavity is the myometrium, which is the muscle. This picture also shows the tubes and ovaries off to each side.

The next picture is a drawing of a bicornuate uterus. It has a portion to the left and a portion to the right. The uterine cavity is not triangular, it is Y shaped. The top middle of the uterus is indented in.

The next picture is a drawing of a septate uterus. (The pictures on this post come from different sources so the drawing style may be a little different). Here, the uterine cavity is Y shaped, just like the bicornuate. The top of the uterus is not indented, it is slightly rounded. Basically, the uterus looks normal on the outside, but has a septum on the inside.

So both have a Y shaped uterine cavity. A hysterogram only shows the uterine cavity. The x-ray dye goes into the cavity and then out the tubes. So a bicornuate uterus and a uterus with a septum can look the same on hysterogram. Other tests are necessary to tell the difference. If your only test has been a hysterogram and you were told you have a bicornuate uterus, you need more tests.
Even more tests may get you the wrong answer. Radiologists are notorious for calling a septate uterus a bicornuate uterus. I don’t know why. Maybe they don’t understand the difference, or they know there is a difference but are not aware that the treatment options (next blog) are different. Even if a special test is ordered, such as an MRI or a 3-d sonohysterogram, the incorrect terminology gets used.

References:

  • Propst AM, Hill JA, 3rd. Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med 2000; 18:341-50.
  • Proctor JA, Haney AF. Recurrent first trimester pregnancy loss is associated with uterine septum but not with bicornuate uterus. Fertil Steril 2003; 80(5):1212-5.
  • Reichman D, Laufer M, Robinson B. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril 2009; 91:1886-1894.
  • Chervena, FA and Neuwirth, RS. Hysteroscopic resection of the uterine septum. Am J Obstet Gynecol. 1981; 39:560-3.
  • Hickok, LR. Hysteroscopic treatment of the uterine septum: a clinician experience. Am J Obstet Gynecol 2000; 182(6):1414-20.