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New Updated Video: Uterine Septum

award winning fertility doctor new york city

 

Dear Readers,

Yes, it has been quite a while since I’ve written. I hope you all have been well and I am excited to return to the blog sphere. It’s not that I have been slacking; I have been writing extensively in other areas, but I do miss the blog so it’s good to be back.
The attached link is to a patient education piece that I produced on uterine septums, which was accepted and presented at the latest meeting of the American Society of Reproductive Medicine. I am very pleased with this final version and I hope some of you find it helpful.

Patient Education: Uterine Septum Video

More to come!

Frederick Licciardi, M.D.
Professor OGBYN
NYU Langone Medical Center

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Dr. Licciardi Performing Surgery to Repair Uterine Septum

award winning fertility doctor new york city

 

Welcome Back,

Today’s blog is a little different, as it is the first one of mine that uses a video.What you will see is actual footage of me performing surgery to repair a large uterine septum.I have viewed many such videos on line and feel that they leave room for improvement. The explanations are not clear; plus I am not impressed with the techniques of many of the surgeons.

It’s very hard for a patient to rate the quality of the surgery they are viewing so I just have to come out and say that what you will see here is surgery of a very high standard.The 3 important things are that I work quickly, I don’t cut away too little, and I don’t cut away too much.If you are curious, you can look at other videos on line and with time you can easily see the differences. Many of the videos show the septum treated by burning it away. I do not like that technique because I think that burning is more likely to lead to scaring. And once you get scar in the uterus, it may be hard for normal function to ever return. You will see I cut with a scissors, which allows for better healing.

I have been working on this video for over a month, and every day see parts that I would like to improve and update (not the surgery part, but the intro photos and some of my voice-overs) .So in time, updated versions will be published, but there is more than enough here to publish now.So here it is; I hope you enjoy it.Feel free to show it to your doctors, I think they will like it too.<Because there is a difference among surgeons, it is wise to seek a second opinion always. Even if you love your own doctor, I would be happy to give you the peace of mind of a second opinion. I have seen many, many women avoid surgery all together simply by taking the extra precaution of a second opinion. It’s well worth it.

Click the link and the video will appear. http://www.youtube.com/watch?v=pf0XIPNnPlo&feature=feedu

For more important information, see my other blogs about uterine septums.

Thanks for viewing, and please read disclaimer 5.17.06.

Dr. Licciardi

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.