Uterine Septum: Weighing Surgery Before Pregnancy

What is a uterine septum?

A uterine septum is a wedge of fibrous and muscular tissue that hangs down from the top of the uterine cavity, present from birth. It forms when the uterus does not fully reshape during fetal development, leaving a partial or complete divide.

A septum is the most common of the congenital uterine shape differences and is often discovered by chance during imaging, a fertility workup, or after a pregnancy loss. Many people with a septum have no symptoms and conceive without difficulty. The concern is not conception itself but the higher chance of miscarriage the septum can bring. Infertility affects about 1 in 6 people of reproductive age according to the World Health Organization, and structural differences like a septum are one factor a workup considers 4Ref 4World Health Organization (2025).Infertility (fact sheet).WHO fact sheet states about 1 in 6 people of reproductive age experience infertility, framing a uterine septum as one structural factor a workup considers..

How does a septum affect pregnancy?

A septum has a poor blood supply, so an embryo that implants on it may struggle to grow. This is thought to explain the link between septa and pregnancy loss, particularly first- and second-trimester miscarriage, as well as higher rates of preterm birth and breech position.

Still, the risk is not uniform. Miscarriage is common in the general population, affecting about 10% of recognized pregnancies according to the American College of Obstetricians and Gynecologists, so not every loss in someone with a septum is caused by it 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 200: Early Pregnancy Loss.ACOG Practice Bulletin No. 200 states early pregnancy loss occurs in about 10% of recognized pregnancies, context for interpreting loss in someone with a septum.. Many people with a septum carry pregnancies to term. Those facing recurrent pregnancy loss are the group in whom a septum is most closely scrutinized.

How is a uterine septum diagnosed?

Accurate diagnosis depends on imaging that shows both the outer shape of the uterus and the inside of the cavity, because a septum can be confused with a different anomaly that is managed differently. Three-dimensional ultrasound and MRI are the most reliable tools.

A hysterosalpingogram or hysteroscopy shows the cavity but not the outer contour, so it is often combined with another scan. According to the American Society for Reproductive Medicine, evaluating the uterine cavity and structure is a standard step in a fertility and recurrent-loss assessment 2Ref 2Practice Committee of the American Society for Reproductive Medicine (2021).Fertility evaluation of infertile women: a committee opinion.ASRM committee opinion establishing that evaluation of the uterine cavity and structure is a standard step in fertility and recurrent-loss assessment, including timing of evaluation.. Getting the diagnosis right matters, because the treatment for a septum differs sharply from other uterine shapes.

Should you have surgery to remove a septum?

Surgery to divide a septum is a short hysteroscopic procedure, but the decision to do it is where the evidence gets genuinely divided. For years, resection was offered routinely to people with a septum and a history of loss, based on studies without comparison groups.

More recent controlled research has questioned whether resection improves live-birth rates, and some guideline groups now describe the supporting evidence as limited 3Ref 3Practice Committee of the American Society for Reproductive Medicine (2026).Recurrent pregnancy loss: a committee opinion.ASRM committee opinion on recurrent pregnancy loss; supports individualized decisions and notes the limited evidence base for some uterine-factor interventions.. That does not make surgery wrong; for someone with repeated losses, it may still be reasonable. It means the choice should weigh your specific history, the septum's size, and your priorities rather than following an automatic rule. Reviewing the options at a fertility consultation helps clarify the trade-offs.

When a uterine septum needs a specialist

A reproductive endocrinologist or gynecologic surgeon can confirm the diagnosis and talk through whether surgery fits your situation. If you have had one or more pregnancy losses, a preterm birth, an incidental septum found while trying to conceive, or difficulty conceiving after 12 months, or 6 months if you are over 35, a focused evaluation makes sense 2Ref 2Practice Committee of the American Society for Reproductive Medicine (2021).Fertility evaluation of infertile women: a committee opinion.ASRM committee opinion establishing that evaluation of the uterine cavity and structure is a standard step in fertility and recurrent-loss assessment, including timing of evaluation.. A septum is present from birth, so it can matter from the first attempts at pregnancy in the teens or twenties through the later reproductive years, and it does not change with the menopausal transition. Because the evidence is mixed, a good specialist presents the trade-offs rather than a one-size answer. Gale can help you prepare for that conversation.