[Hysteroscopic surgery and fertility]

In the treatment of uterine lesions associated with infertility, such as septate uterus and synechiae, hysteroscopic surgery has replaced conventional abdominal surgery. Hysteroscopic metroplasty improves obstetrical prognosis in patients with septate uterus. Advantages of hysteroscopy are low morbidity rate, decreased hospitalization time, and absence of hysterotomy. Hysteroscopic surgery of synechiae allows to achieve good anatomical results in most of the cases. The first risk of this surgery is perforation. However, obstetrical results are uneven; pregnancy rates are low in cases of complex synechiae. Endometrial ablation is performed in patients presenting with abnormal uterine bleeding after failure of progestin therapy. Pregnancies following endometrial ablation have been described; term deliveries are still exceptional.