Hysteroscopic Uterine Septum Resection: Is it a Successful Treatment for Infertile Patients?

Dear Editor, We would like to comment on "Evaluation of the Success of Hysteroscopic Uterine Septum Resection."1 The results of hysteroscopic uterine septum resection in 38 patients with uterine septum were evaluated in this study. The preoperative and postoperative septal apex to uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) measurements were compared. The patients' pregnancies were tracked for a year after surgery. The findings revealed that 18 of the 38 patients (47.36%) who underwent uterine septum resection became pregnant, with 13 (72.2%) of these pregnancies resulting in live births. 14 of the 18 patients (77.7%) were able to conceive naturally. Term pregnancy occurred in 11 of 16 patients with a partial septum (68.7%) and in 2 of 3 patients (66.6%) with a complete septum. When comparing pre- and postoperative three-dimensional transvaginal ultrasound measurements of the uterus, the researchers discovered a decrease in s1 and an increase in s2 (P = 0.05). Furthermore, pregnant patients had longer uterine cavities than nonpregnant patients (P = 0.05). Limited Applicability of Findings: The ability to generalize the findings was constrained due to the relatively small sample size. The limitation of the small sample size was explicitly stated in the constraints.2 Lack of Randomization Information: The study did not specify whether patients were randomly assigned to the treatment group or if they chose the procedure on their own. (Without randomization, there may be bias in-patient selection, potentially affecting the study's outcomes.) Patients were randomly selected during the preoperative period, and blind ultrasound (USG) was performed during postoperative measurements. Inclusion of Specific Patient Group: Since the study only included patients undergoing uterine septum resection, the findings may not be applicable to all patients with uterine septum. This could introduce selection bias and limit the generalizability of the results. Unfortunately, due to the retrospective nature of the study, a control group could not be evaluated.3 Inadequate Long-Term Follow-up: The study followed patients only one year after surgery. A longer follow-up would have allowed for a more comprehensive assessment of the long-term effects of uterine septum resection on pregnancy outcomes. Since most studies in the literature also follow up for 12 months, and unfortunately, many patients came from out of town, there was no chance for longer-term follow-up. Additionally, there is no clarity in the publications regarding postoperative patient follow-up. There are studies in the literature that include follow-ups at 12 months and 24 months.4 Single-Center Study: The fact that the study was conducted at a single center may limit its external validity. Additionally, patients in the study were only followed for one year after surgery, which may not accurately represent long-term outcomes. The retrospective study design restricted this study. Confirmation of Findings: Future studies with larger sample sizes and longer follow-up periods are needed to validate the findings and determine the true efficacy of hysteroscopic uterine septum resection. In literature, we need prospective, larger sample and longer follow-up periods for future studies. Data availability statement Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.