Screening for uterine abnormalities by three-dimensional ultrasound improves perinatal outcome

The main goal of our study was to assess the true incidence of surgically correctable uterine abnormalities (congenital uterine anomalies, submucous leiomyoma, endometrial polyps and intrauterine synechiae) in the infertile population attending our tertiary infertility clinic. All of the infertile patients enrolled in the study were evaluated by three-dimensional ultrasound. Another objective was to assess pregnancy rates before and after operative hysteroscopy in patients affected by uterine causes of infertility. Good quality 3D images were obtained in all 3850 infertile patients, and in 23.2% of them 3D US revealed surgically correctable uterine abnormalities. The incidence of uterine septum in our general infertile population was 17.9%. Uterine septum was the most common uterine abnormality accounting for 77.1% of the intracavitary lesions. Out of 310 patients that were followed-up, 225 (72.6%) patients achieved pregnancy. The rate of term deliveries after septal incision was 57.7%, while 15.4% of patients had preterm deliveries. The rate of spontaneous abortions dropped from 41.7% before, to 11.9% after hysteroscopic resection of the septum. Three-dimensional ultrasound can be used as a screening method for detection of uterine abnormalities in patients suffering from infertility. We found significant improvement in reproductive outcome after operative hysteroscopy in secondary infertile patients with septate uterus and/or other uterine abnormalities.