{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:30:03Z","timestamp":1792189803677,"version":"4.4.0"},"reference-count":83,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T00:00:00Z","timestamp":1654646400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: we performed a systematic review\/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile\/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value &lt; 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology\/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27\u20130.76; p &lt; 0.0001; and OR 0.21, 95% CI 0.12\u20130.39; p &lt; 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90\u20136.36; p &lt; 0.0001; OR 2.56, 95% CI 1.52\u20134.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49\u20132.49; p = 0.82 and OR 0.81, 95% CI 0.35\u20131.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21\u20131.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93\u201382.13; p &lt; 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02\u20130.04; p &lt; 0.000 and OR 0.05, 95% CI 0.03\u20130.08; p &lt; 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA.<\/jats:p>","DOI":"10.3390\/jcm11123290","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T02:25:33Z","timestamp":1654827933000},"page":"3290","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes\u2014A Systematic Review and Meta-Analysis of Observational Research"],"prefix":"10.3390","volume":"11","author":[{"given":"Marco","family":"Noventa","sequence":"first","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Spagnol","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Saccardi","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Bonaldo","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1543-2802","authenticated-orcid":false,"given":"Antonio Simone","family":"Lagan\u00e0","sequence":"additional","affiliation":[{"name":"Unit of Gynecology Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities (PROMISE), University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cavallin","sequence":"additional","affiliation":[{"name":"Independent Researcher, 36020 Solagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Andrisani","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Ambrosini","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore Giovanni","family":"Vitale","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Alonso","family":"Pacheco","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Centro Gutenberg, 29003 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9476-628X","authenticated-orcid":false,"given":"Sergio","family":"Haimovich","sequence":"additional","affiliation":[{"name":"Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera 38100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attilio","family":"Di Spiezio Sardo","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Carugno","sequence":"additional","affiliation":[{"name":"Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5757-2793","authenticated-orcid":false,"given":"Marco","family":"Scioscia","sequence":"additional","affiliation":[{"name":"Unit of Gynecology, Mater Dei Hospital, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Garzon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Bettocchi","sequence":"additional","affiliation":[{"name":"Inter-Departmental Project Unit of Minimal-Invasive Gynecological Surgery, Policlinico of Bari, University of Bari Aldo Moro, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9466-0178","authenticated-orcid":false,"given":"Giovanni","family":"Buzzaccarini","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Tozzi","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2824-5435","authenticated-orcid":false,"given":"Amerigo","family":"Vitagliano","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women and Children\u2019s Health, University of Padua, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.jmig.2011.03.017","article-title":"Metroplasty in a large population of women with septate uterus","volume":"18","author":"Paradisi","year":"2011","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_2","first-page":"335","article-title":"Evidence-based management of recurrent miscarriage","volume":"1","author":"Acien","year":"2004","journal-title":"Surg. Manag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/humupd\/7.2.161","article-title":"Clinical implications of uterine malformations and hysteroscopic treatment results","volume":"7","author":"Grimbizis","year":"2001","journal-title":"Hum. Reprod. Update"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S1701-2163(16)32069-2","article-title":"Fertility and pregnancy outcomes following hysteroscopic septum division","volume":"28","author":"Vilos","year":"2006","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"American Fertility Society (1988). The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, m\u00fcllerian anomalies and intrauterine adhesions. Fertil. Steril., 49, 944\u2013955.","DOI":"10.1016\/S0015-0282(16)59942-7"},{"key":"ref_6","unstructured":"Practice Committee of the American Society for Reproductive Medicine (2016). Uterine septum: A guideline. Fertil. Steril., 106, 530\u2013540."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1093\/humrep\/det098","article-title":"The ESHRE\/ESGE consensus on the classification of female genital tract congenital anomalies","volume":"28","author":"Grimbizis","year":"2013","journal-title":"Hum. Reprod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/uog.18923","article-title":"Congenital Uterine Malformation by Experts (CUME): Better criteria for distinguishing between normal\/arcuate and septate uterus?","volume":"51","author":"Ludwin","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"558.e1","DOI":"10.1016\/j.ajog.2011.07.022","article-title":"Congenital uterine anomalies and adverse pregnancy outcomes","volume":"205","author":"Hua","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1002\/uog.18935","article-title":"Outcome of assisted reproduction in women with congenital uterine anomalies: A prospective observational study","volume":"51","author":"Prior","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jmig.2012.09.010","article-title":"Hysteroscopic metroplasty for the septate uterus: Review and meta-analysis","volume":"20","author":"Valle","year":"2013","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00404-002-0378-4","article-title":"Reproductive outcome of septate uterus after hysteroscopic metroplasty","volume":"268","author":"Yildiz","year":"2003","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.rbmo.2014.09.006","article-title":"Clinical implications of congenital uterine anomalies: A meta-analysis of comparative studies","volume":"29","author":"Venetis","year":"2014","journal-title":"Reprod. Biomed. Online"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1093\/oxfordjournals.humrep.a137860","article-title":"Reproductive performance of women with uterine malformations","volume":"8","year":"1993","journal-title":"Hum. Reprod."},{"key":"ref_15","first-page":"684","article-title":"Hysteroscopically detected asymptomatic m\u00fcllerian anomalies. Prevalence and reproductive implications","volume":"40","author":"Maneschi","year":"1995","journal-title":"J. Reprod. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1093\/humrep\/12.10.2277","article-title":"Reproductive impact of congenital M\u00fcllerian anomalies","volume":"12","author":"Raga","year":"1997","journal-title":"Hum. Reprod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1016\/j.fertnstert.2008.04.011","article-title":"Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: A prospective controlled trial","volume":"91","author":"Mollo","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ejogrb.2010.11.015","article-title":"Determinants of fertility and reproductive success after hysteroscopic septoplasty for women with unexplained primary infertility: A prospective analysis of 88 cases","volume":"155","author":"Shokeir","year":"2011","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ijgo.2010.11.023","article-title":"Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility","volume":"113","author":"Tonguc","year":"2011","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S1074-3804(05)60559-2","article-title":"Histologic architecture and vascularization of hysteroscopically excised intrauterine septa","volume":"8","author":"Sparac","year":"2001","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1111\/1471-0528.15798","article-title":"The pathophysiology of the septate uterus: A systematic review","volume":"126","author":"Rikken","year":"2019","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1093\/humrep\/deab037","article-title":"Septum resection versus expectant management in women with a septate uterus: An international multicentre open label randomized controlled trial","volume":"36","author":"Rikken","year":"2021","journal-title":"Hum. Reprod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/0002-9610(46)90190-0","article-title":"Malformations of the uterus","volume":"71","author":"Jarcho","year":"1946","journal-title":"Am. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0015-0282(16)44114-2","article-title":"M\u00fcllerian anomalies: A proposed classification. (An analysis of 144 cases)","volume":"32","author":"Buttram","year":"1979","journal-title":"Fertil. Steril."},{"key":"ref_26","first-page":"1099","article-title":"Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening","volume":"98","author":"Woelfer","year":"2001","journal-title":"Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S1472-6483(10)60876-0","article-title":"Is hysteroscopic correction of an incomplete uterine septum justified prior to IVF?","volume":"14","author":"Ozgur","year":"2007","journal-title":"Reprod. Biomed. Online"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ijgo.2007.04.022","article-title":"Uterine anomalies and pregnancy outcome following resectoscope metroplasty","volume":"98","author":"Zlopasa","year":"2007","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ejogrb.2008.04.010","article-title":"The outcome of singleton pregnancies after IVF\/ICSI in women before and after hysteroscopic resection of a uterine septum compared to normal controls","volume":"146","author":"Tomazevic","year":"2009","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1016\/j.fertnstert.2008.12.097","article-title":"Midline uterine defect size is correlated with miscarriage of euploid embryos in recurrent cases","volume":"93","author":"Ozaki","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.rbmo.2010.06.028","article-title":"Septate, subseptate and arcuate uterus decrease pregnancy and live birth rates in IVF\/ICSI","volume":"21","author":"Verdenik","year":"2010","journal-title":"Reprod. Biomed. Online"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.rbmo.2009.11.021","article-title":"The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage","volume":"20","author":"Saravelos","year":"2010","journal-title":"Reprod. Biomed. Online"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1002\/uog.8968","article-title":"Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment","volume":"37","author":"Jayaprakasan","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S1074-3804(05)80221-X","article-title":"Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic metroplasty or no surgical treatment","volume":"4","author":"Heinonen","year":"1997","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S1074-3804(05)60206-X","article-title":"Hysteroscopic metroplasty improves gestational outcome in women with recurrent spontaneous abortion","volume":"11","author":"Valli","year":"2004","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ijgo.2008.11.018","article-title":"Reproductive outcome following resectoscope metroplasty in women having a complete uterine septum with double cervix and vagina","volume":"105","author":"Lin","year":"2009","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.ijgo.2011.07.030","article-title":"Not every subseptate uterus requires surgical correction to reduce poor reproductive outcome","volume":"115","author":"Pang","year":"2011","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3109\/01443615.2014.936839","article-title":"Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies?","volume":"35","author":"Lin","year":"2015","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1093\/humrep\/deaa141","article-title":"Septum resection in women with a septate uterus: A cohort study","volume":"35","author":"Rikken","year":"2020","journal-title":"Hum. Reprod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/AOG.0000000000003953","article-title":"Pregnancy Outcomes in Women With a History of Recurrent Early Pregnancy Loss and a Septate Uterus, With and Without Hysteroscopic Metroplasty","volume":"136","author":"Whelan","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1097\/00006250-198602000-00017","article-title":"Hysteroscopic treatment of the septate uterus","volume":"67","author":"Valle","year":"1986","journal-title":"Obstet. Gynecol."},{"key":"ref_42","first-page":"321","article-title":"Hysteroscopic treatment of uterine septum","volume":"20","author":"Guarino","year":"1989","journal-title":"Acta Eur. Fertil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0015-0282(16)54780-3","article-title":"Hysteroscopic treatment of septate uterus with Neodymium-YAG laser","volume":"57","author":"Choe","year":"1992","journal-title":"Fertil. Steril."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1093\/humrep\/13.5.1188","article-title":"Hysteroscopic septum resection in patients with recurrent abortions or infertility","volume":"13","author":"Grimbizis","year":"1998","journal-title":"Hum. Reprod."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0020-7292(98)00154-4","article-title":"Management of septate uterus by flexible hysteroscopy and Nd:YAG laser","volume":"63","author":"Jourdain","year":"1998","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0301-2115(99)00126-8","article-title":"Hysteroscopic metroplasty for septate uterus and repetitive abortions: Reproductive outcome","volume":"88","author":"Porcu","year":"2000","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s004040100217","article-title":"A study of hysteroscopic metroplasty in 141 women with a septate uterus","volume":"266","author":"Venturoli","year":"2002","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1089\/pho.2006.24.625","article-title":"Reproductive outcome of septate uterus after hysteroscopic treatment with neodymium:YAG laser","volume":"24","author":"Yang","year":"2006","journal-title":"Photomed. Laser Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2643","DOI":"10.1016\/j.fertnstert.2008.04.009","article-title":"Hysteroscopic septum resection of complete septate uterus with cervical duplication, sparing the double cervix in patients with recurrent spontaneous abortions or infertility","volume":"91","author":"Wang","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s00404-009-1336-1","article-title":"Reproductive outcome following hysteroscopic septal resection in patients with infertility and recurrent abortions","volume":"283","author":"Roy","year":"2011","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_51","first-page":"287","article-title":"Reproductive outcomes after hysteroscopic metroplasty for uterine septum","volume":"37","author":"Sendag","year":"2010","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.rbmo.2012.01.025","article-title":"No clinical relevance of the height of fundal indentation in subseptate or arcuate uterus: A prospective study","volume":"24","author":"Gergolet","year":"2012","journal-title":"Reprod. Biomed. Online"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jmig.2012.11.002","article-title":"Metroplasty for AFS Class V and VI septate uterus in patients with infertility or miscarriage: Reproductive outcomes study","volume":"20","author":"Bendifallah","year":"2013","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"235","DOI":"10.3109\/01443615.2013.836477","article-title":"Reproductive outcomes after resection of intrauterine septum","volume":"34","author":"Gundabattula","year":"2014","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s00404-013-3003-9","article-title":"Hysteroscopic metroplasty: Reproductive outcome in relation to septum size","volume":"289","author":"Paradisi","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"S110","DOI":"10.1016\/j.jmig.2015.08.299","article-title":"Reproductive Outcome Analysis of 286 Women Who Underwent Hysteroscopic Septum Resection for Complete and Partial Septum of the Uterus","volume":"22","author":"John","year":"2015","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.3109\/14767058.2014.981746","article-title":"Reproductive outcomes following uterine septum resection","volume":"28","author":"Freud","year":"2015","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e16623","DOI":"10.1097\/MD.0000000000016623","article-title":"Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa: A retrospective cohort study protocol","volume":"98","author":"Wang","year":"2019","journal-title":"Medicine"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (minors): Development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_61","unstructured":"R Core Team (2020). R: A language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, W.A. (2020). Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons. Available online: www.training.cochrane.org\/handbook.","DOI":"10.1002\/9781119536604"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1093\/humrep\/deaa230","article-title":"Septate uterus and reproductive outcomes: Let\u2019s get serious about this","volume":"35","author":"Ata","year":"2020","journal-title":"Hum. Reprod."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1002\/uog.10056","article-title":"Reproductive outcomes in women with congenital uterine anomalies: A systematic review","volume":"38","author":"Chan","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"545.e1","DOI":"10.1016\/j.ajog.2015.06.008","article-title":"Trends in timing of prenatal diagnosis and abortion for fetal chromosomal abnormalities","volume":"213","author":"Hume","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_69","first-page":"3086036","article-title":"Human Papillomavirus Infection as a Possible Cause of Spontaneous Abortion and Spontaneous Preterm Delivery","volume":"2016","author":"Baandrup","year":"2016","journal-title":"Infect. Dis. Obstet. Gynecol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/01.ogx.0000261644.89300.df","article-title":"The role of oxidative stress in spontaneous abortion and recurrent pregnancy loss: A systematic review","volume":"62","author":"Gupta","year":"2007","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.jmig.2016.01.020","article-title":"Accuracy of Hysteroscopic Metroplasty With the Combination of Presurgical 3-Dimensional Ultrasonography and a Novel Graduated Intrauterine Palpator: A Randomized Controlled Trial","volume":"23","author":"Zizolfi","year":"2016","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jmig.2017.08.009","article-title":"Office Operative Hysteroscopy: An Update","volume":"25","author":"Salazar","year":"2018","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1093\/humrep\/deab081","article-title":"\u2018It\u2019s all too much\u2019: The shadow of overtreatment looms over hysteroscopic metroplasty for septate uterus","volume":"36","author":"Vercellini","year":"2021","journal-title":"Hum. Reprod."},{"key":"ref_74","first-page":"CD009461","article-title":"Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities","volume":"12","author":"Bosteels","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00404-021-05975-2","article-title":"Does hysteroscopic resection of uterine septum improve reproductive outcomes: A systematic review and meta-analysis","volume":"303","author":"Krishnan","year":"2021","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jmig.2021.10.001","article-title":"Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis","volume":"29","author":"Carrera","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0015-0282(99)00480-X","article-title":"The septate uterus: A review of management and reproductive outcome","volume":"73","author":"Homer","year":"2000","journal-title":"Fertil. Steril."},{"key":"ref_78","first-page":"311","article-title":"Endometrial patterns in malformed uteri","volume":"14","author":"Candiani","year":"1983","journal-title":"Acta Eur. Fertil."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.jmig.2019.11.019","article-title":"Resectoscopic Metroplasty with Uterine Septum Excision: A Histologic Analysis of the Uterine Septum","volume":"27","author":"Fascilla","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/humupd\/6.1.75","article-title":"The role of HOX genes in human implantation","volume":"6","author":"Taylor","year":"2000","journal-title":"Hum. Reprod. Update"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/0002-9378(95)90093-4","article-title":"Septate uterus: New idea on the histologic features of the septum in this abnormal uterus","volume":"172","author":"Dabirashrafi","year":"1995","journal-title":"Am. J. Obstet. Gynecol"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/S0015-0282(16)58208-9","article-title":"Ultrastructural aspects of endometrium in Infertile women with septate uterus","volume":"65","author":"Fedele","year":"1996","journal-title":"Fertil. Steril."},{"key":"ref_83","unstructured":"National Institute for Health and Care Excellence (2022, May 01). Hysteroscopic Metroplasty of a Uterine Septum for Primary Infertility\u2014Interventional Procedures Guidance, Available online: nice.org.uk\/guidance\/ipg509."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3290\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:26:26Z","timestamp":1760138786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,8]]},"references-count":83,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcm11123290"],"URL":"https:\/\/doi.org\/10.3390\/jcm11123290","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,8]]}}}