Key messages
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Based on one randomised trial, there may be little to no difference in live birth and ongoing pregnancy between septum resection (surgical removal of the septum) and expectant management (watch-and-wait).
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We have very low confidence in the findings from non-randomised studies.
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More high-quality studies are needed to increase our confidence in the results.
What is septate uterus?
A septate uterus is an abnormality of the uterus (womb) existing from birth, where the womb is divided into two cavities. Women with a septate uterus are at risk for infertility, recurrent miscarriage, and preterm birth. Surgery to remove the septum is thought to improve these outcomes, but the effectiveness of the procedure is unclear.
What did we want to find out?
We wanted to know whether hysteroscopic septum resection (surgical removal of the septum) improves the chances of a live birth in women with a septate uterus, and whether these benefits outweigh the possible complications of the procedure.
What did we do?
We looked at the research from randomised controlled trials (RCTs), which are studies where people are assigned to one of two or more treatment groups using a random method. Such studies are considered high quality. We also looked at non-randomised studies, for example studies that review and analyse medical records. Such studies are considered very low quality.
What did we find?
We found one RCT and 12 non-randomised studies, of which 10 studies reviewed and analysed medical records. All studies compared septum resection to expectant management (watch-and-wait). In the RCT, 39 women received septum resection and 40 women received expectant management. In the 12 non-randomised studies, 1134 women received septum resection and 692 women received expectant management.
Main results
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Results from the RCT suggest there may be little to no difference in live birth between septum resection and expectant management. Based on the results from non-randomised studies, we are uncertain whether septum resection could increase live birth.
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The RCT reported one uterine perforation (hole or tear in the wall of the uterus) and one residual septum (remaining portion of septum not removed during surgery). Of the non-randomised studies that reported on surgical complications, three described no complications, and three reported mainly uterine perforation, bleeding, or residual septum requiring repeat surgery. The remaining studies did not report on complications.
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Results from the RCT suggest there may be little to no difference in ongoing pregnancy between septum resection and expectant management. Based on the results from non-randomised studies, we are uncertain whether septum resection affects ongoing pregnancy.
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Results from the RCT suggest there may be little to no difference in clinical pregnancy (where the signs of the fetus can be seen or heard) between septum resection and expectant management. Based on the results from non-randomised studies, we are uncertain whether septum resection could increase clinical pregnancy.
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Septum resection may increase miscarriage compared to expectant management; however, the study was very small, so we have little confidence in the evidence. Based on the results from non-randomised studies, we are uncertain if septum resection decreases miscarriage compared to expectant management.
What are the limitations of the evidence?
We have little confidence in the RCT evidence, as the study was very small, and there are not enough studies to be certain about the results. We have very low confidence in the evidence from the non-randomised studies, as the studies were done in different types of people, and it is possible that people in the studies knew which treatment they were getting.
How up-to-date is the evidence?
The evidence is current to September 2025.
Read the full abstract
Women with a septate uterus are at increased risk for subfertility, recurrent miscarriage, and preterm birth. Restoration of the anatomy of the uterus by hysteroscopic septum resection is an established intervention. This treatment has been assessed mainly in retrospective cohort studies, which suggested a positive effect on pregnancy outcomes. The major flaw in these studies is the before/after design, which will always favour the tested intervention.
Objectives
To evaluate the benefits and harms of septum resection in women of reproductive age with a septate uterus compared to expectant management.
Search strategy
We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, and PsycINFO databases on 22 September 2025. We also searched trial registries and reference lists from relevant papers and contacted experts in the field for any additional studies. This is an update of a Cochrane review first published in 2011 and previously updated in 2017.
Selection criteria
We planned to include randomised controlled trials that assessed the effect on reproductive outcomes and the safety of hysteroscopic septum resection in women of reproductive age with a septate uterus.
Data collection and analysis
If there had been studies to include, two review authors would have independently selected studies, assessed trial risk of bias, and extracted data. They would also have contacted study authors for additional information.
Main results
As in the 2011 version of this review, we identified no randomised controlled trials for inclusion in this update.
Authors' conclusions
Based on the currently available RCT evidence, there may be little or no difference in live birth, ongoing pregnancy, and clinical pregnancy between septum resection and expectant management. Miscarriage may be slightly increased in the septum resection group, although the CI included the possibility of no effect. Based on results from non-randomised studies, we are uncertain whether septum resection affects pregnancy outcomes, as the certainty of the evidence was very low.
Funding
This review had no dedicated funding.
Registration
Protocol (2010): https://doi.org/10.1002/14651858.CD008576.pub2
Review (2011): https://doi.org/10.1002/14651858.CD008576.pub3
Review update (2017): https://doi.org/10.1002/14651858.CD008576.pub4
