I have a uterine septum that completely divides my uterus. I only have one cervix, but it has two openings. My septum is fairly thick. Due to my endometriosis and my inability to get pregnant for the past two years, my doctor is recommending removing the septum. Hopefully the surgery will help both of these problems and also better my chances of carrying full-term if I do get pregnant. My question is this: Which method of surgery is recommended -- open-abdominal or transcervical? Also, how common is this condition, and the surgery to repair it? My doctor has performed this only once before. Would it be possible for me to find a facility whose doctors are more experienced with this procedure?

Dion

It is not entirely clear to me exactly what type of uterine abnormality you have. If you have two separate uterine horns each connecting to a single cervical opening, the anomaly is called uterine didelphys and I would expect you to do quite well during pregnancy. This condition should not cause infertility. There is a slightly increased risk of early delivery, and your physician would want to monitor your pregnancy more closely as you approach the last trimester of pregnancy. But unless you have a history of recurrent third-trimester pregnancy loss, surgery for this condition should be avoided. Uterine didelphys cannot be repaired through the vagina. The surgery to repair this condition requires an open abdominal procedure and often has complications that cause greater fertility and pregnancy-related problems.

If you truly have a single cervix and a single uterus with a wall dividing the inner uterine cavity into two halves (meaning the outer wall of the uterus is smooth and not heart-shaped), then you have a uterine septum and hysteroscopic resection is the best approach.

When it comes to getting the most appropriate surgery to correct a uterine anomaly, to treat infertility, and to preserve or restore your fertility, you would do best to see a fellowship-trained reproductive endocrinologist has advanced surgical skills in this area. I certainly would not want to have surgery by someone who has only done the particular surgery once before.