False passage is a possible complication during operative hysteroscopy and can lead to termination of the intended procedure. The aim of this study is to describe two techniques to overcome the complication of false passage during operative hysteroscopy. This is a retrospective case series of 9 patients who had a false passage during operative hysteroscopy for Müllerian anomaly or endometrial polyps. The diagnosis was immediately made by visualization of a lattice network of myometrial fibers without normal landmarks of the endometrial cavity and tubal ostia. Once a false passage was suspected, an attempt was made to overcome this complication and complete the intended operative hysteroscopy. The hysteroscope was slowly withdrawn to identify both the false passage and the opening towards the internal cervical os. The hysteroscope was tilted towards the opening to the internal cervical os, and it was carefully advanced under direct vision into the endometrial cavity. In two patients, this technique failed because the opening to the internal cervical os was small, so the bridge of tissue between the internal os and false passage was partially divided using hysteroscopic scissors or a straight resectoscope loop, allowing for entry into the endometrial cavity. The intended procedures were completed successfully in all patients. No intraoperative or postoperative complications occurred as a result of the two techniques. The techniques described in this study, to overcome false passage during operative hysteroscopy, appear to be safe, effective, and easy to perform. They enable the surgeon to complete the intended procedure.

Objective To revive the use of the Kahn Uterine Trigger Cannula to overcome limitations associated with technical difficulties during hysterosalpingography (HSG) using the disposable balloon HSG catheter. Method A case series was conducted of 17 patients who encountered technically difficult or incomplete HSG study while using a disposable HSG balloon catheter, also leading to false-positive findings. Nine patients underwent a repeat HSG using a Kahn Uterine Trigger Cannula (Group 1). Eight patients underwent diagnostic laparoscopy and tubal perfusion testing using a Kahn Uterine Trigger Cannula (Group 2). The findings for each group in comparison to their initial HSG results using the disposable balloon HSG catheter are described. Results All patients were noted to have patent fallopian tubes using a Kahn Uterine Trigger Cannula on repeat HSG or tubal perfusion testing during laparoscopy. Conclusion Providers who perform HSG studies should be familiar with the value of a Kahn Uterine Trigger Cannula when the traditional use of disposable HSG balloon catheter fails due to technical difficulty or incomplete study. The use of the Kahn Uterine Trigger Cannula in such situations can prevent inaccurate assessment and unnecessary interventions.

False passage is a rare complication during hysteroscopy. It is more common to occur when there is a problematic cervix or when there is cervical stenosis. It also can occur when the uterus is in an acutely anteflexed, anteverted or retroverted position. This complication can lead to a false diagnosis of intrauterine scar tissue, high fluid deficit, possible uterine perforation, and early abandonment of the intended hysteroscopic procedure. The aim of this study is to describe various techniques to overcome this complication, hence increasing the ability of the surgeon to successfully complete the procedure. Our study is a case series of 9 patients who had an inadvertent false passage creation during hysteroscopy. In all these patients, the initial planned procedure was a diagnostic hysteroscopy followed by operative hysteroscopy for suspected endometrial polyps (4 patients) or uterine septum (5 patients). The diagnosis was immediately made by visualization of lattice network of myometrial fibers without normal landmarks of endometrial cavity and tubal ostia. All hysteroscopies were performed under modified general anesthesia using a 0 or 12 degree Gyrus ACMI (Olympus) hysteroscope. The Gyrus ACMI hysteroscope setup allows for the hysteroscopic lens to be introduced through the obturator piece and advancement of the hysteroscope under direct vision. In turn, this provides continuous optical contact with the working area. Normal saline used as a distension medium for initial diagnostic hysteroscope was replaced with Glycine 1.5%, if operative interventions required the use of monopolar current. No pre- or post-operative antibiotic was used. Once a false passage was suspected, an attempt was made to overcome this problem. First the patient’s position was adjusted such that the patient buttocks were even with the lower break of the table allowing for maximum manipulation of hysteroscope. The hysteroscope was slowly withdrawn in the cervical canal, to identify both the false passage and the internal os. The weight speculum was replaced by a Deaver Retractor to further enable better manipulation of the hysteroscope. A tilt in the tip of hysteroscope was made in the direction of the internal os which was then negotiated as the hysteroscope was carefully advanced into the endometrial cavity. In three patients this technique failed, so the bridge of tissue between the internal os and false passage was partially divided using hysteroscopic scissors or straight resectoscope loop, enlarging the correct entrance and allowing for entry into the endometrial cavity. The intended procedures were completed successfully. No intra-operative or post-operative complications occurred as a result of our techniques. In conclusion, the techniques described in this study to overcome false passage during hysteroscopy, appear to be safe, effective, and easy to perform. They enable the surgeon to complete the intended procedure.

An amendment to this paper has been published and can be accessed via the original article.

Our patients in this case series presented to a private reproductive endocrinology office for infertility (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018).During infertility work up, the diagnosis of endometrial cancer or precursor lesions was established after a diagnostic hysteroscopy dilatation and curettage (D&C) (Figure 1).The patients had variable characteristics contributing to their infertility.The aim of this case series is to discuss the reproductive outcomes of six patients who underwent in vitro fertilization (IVF) following conservative management.

Purpose To determine the accuracy of transvaginal 3D ultrasound scan (TV 3D US) in detecting partial septate uterus (PSU) in patients with recurrent pregnancy loss (RPL). Methods This retrospective study included 113 patients with an initial diagnosis of unexplained RPL, who were subsequently found to have PSU on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The diagnosis of PSU was made at the time of a diagnostic hysteroscopy based on ESHRE-ESGE classification of Müllerian anomalies. Based on hysteroscopic findings, patients were divided into two groups: those with PSU and a central point of indentation at an acute angle < 90° (PSUAA) [30.1%], and those who had PSU and a central point of indentation at an obtuse angle (PSUOA) [69.9%]. We compared the mean internal indentation length at the fundal midline (IILFM) in millimeters on TV 3D US and on diagnostic hysteroscopy. For the purpose of this study, a diagnosis of PSU on hysteroscopy was made if IILFM measured ≥ 10 mm. Results The mean IILFM (mm) on hysteroscopy was significantly higher than the mean IILFM (mm) measured on TV 3D US in patients with PSUAA (18.5 ± 6.5 vs 4.9 ± 4.4; P < 0.001), in patients with PSUOA (14.1 ± 3.8 vs 4.3 ± 3.4; P < 0.001), and in the overall population (15.3 ± 5.1 vs 4.1 ± 4.4; P < 0.001). Conclusions The data suggest that mean IILFM in patients with RPL and PSU can be underestimated on TV 3D US. Therefore, its diagnostic accuracy in such patients may need further evaluation.

The prevalence of septate/subseptate and arcuate uterine anomaly in infertile patients varies in the literature due to different modes of diagnoses and methodological bias. Our group previously reported that mid fundal length on transvaginal 3D US (TV 3D US) with or without saline infusion sonohysterography (SIH) tends to be underestimated in patients with subtle incomplete septum and arcuate uterine anomaly (Abuzeid O. et al. Fertil Steril 2015). The aim of this study is to determine the prevalence of significant subseptate and arcuate uterine anomaly on hysteroscopy and TV 3D US in infertile patients with reproductive failure. All patients who presented to our unit with a history of infertility (2008 – 2016) were studied. Optimal testing for the diagnosis of arcuate and septate/subseptate uterus (ASRM Class Vb and VI) was used. The criterion for optimal testing was TV 3D US with or without SIH, and hysteroscopy with or without laparoscopy. Five hundred fifty six patients who fulfilled inclusion criteria were included in this study. Inclusion criteria included the diagnosis of subseptate or arcuate uterus on hysteroscopy and TV 3D US with or without SIH with measurement of mid fundal protrusion length. For this study we used strict criteria for the diagnoses of the above-mentioned anomalies on hysteroscopy. Such criteria would be a mid fundal protrusion length of ≥15 mm. Such measurement was done at time of diagnostic hysteroscopy using straight resectoscope loop. The TV 3D US definition of such anomalies was a mid fundal protrusion length ≥10 mm. Mean age (years) was 32.6 ± 5.2, mean duration of infertility (years) was 2.9 ± 2.5, mean BMI (kg/m2) was 27.3 ± 6.8, mean FSH level (mIU/ml) was 7.1 ± 2.9 and primary infertility was present in 68.7%. Of the 556 patients included in this analysis, 83 patients had significant subseptate uterus and 161 patients had significant arcuate uterine anomaly on hysteroscopy. Fourteen patients had subseptate uterus and 12 patients had arcuate uterine anomaly on TV 3D US. The prevalence of significant subseptate uterus (14.9%) and arcuate uterine anomaly (29.0%) on hysteroscopy was significantly higher than the prevalence subseptate uterus (2.5%) and arcuate uterine anomaly (2.2%) on TV 3D US (p = 0.000). Our data suggest that TV 3D US tends to underestimate the prevalence of significant subseptate uterus and arcuate uterine anomaly compared to hysteroscopy. Prevalence of such anomalies in infertility patients is much higher than what is reported in the literature. Diagnostic hysteroscopy is the gold standard for diagnosis of such anomalies.

The role of arcuate uterine anomaly in patients with RPL is not universally accepted. The aim of this study is to compare reproductive outcome in patients with RPL after hysteroscopic division of subseptate uterus or arcuate uterine anomaly. One hundred forty-eight patients with secondary infertility and RPL, defined as ≥2 consecutive miscarriages, who were found to have subseptate uterus (60 patients, Group 1) or arcuate uterine anomaly (88 patients, Group 2) on hysteroscopy (1992 – 2016) were studied. At the time of hysteroscopy the type of uterine anomalies according to ASRM classification (Class Vb or Class VI) was documented and its mid fundal protrusion length was measured using the tip of a straight resectoscope loop. If the subseptate uterus or arcuate uterine anomaly was deemed clinically significant (mid fundal protrusion length ≥10 mm) it was divided at the same session. Depending on the underlying etiology couples were allowed to try to achieve pregnancy spontaneously (SC), with Clomid treatment (CT), intrauterine insemination after controlled ovarian stimulation (COS) or in-vitro fertilization and embryo transfer (IVF-ET). Follow up was up to 3 years. Paired test and, Chi-square and logistic regression were used for statistical analysis where appropriate. There was no significant difference in female age (years), duration of secondary infertility (years), BMI (Kg/m2), day 3 serum FSH levels (mIU/mL), number of miscarriage, and incidence of ovulatory disorders, tubal factors or endometriosis between the two groups. There was significantly higher incidence of male factor infertility in Group 1 (15.0%) in Group 1 compared to Group 2 (4.5%) [p = 0.027]. There was no significant difference in the clinical pregnancy (72.4% vs 59.3%), delivery/ongoing pregnancy (60.0% vs 47.7%), miscarriage (11.9% vs 15.7%), ectopic (2.4% vs 2.0%), and multiple birth (22.6% vs 18.8%) rates between the two groups. There was no significant difference in the method of conception between the two groups (47.5%, 10.0%, 5.0%, and 37.5% vs 38.0%, 4.0%, 10.0%, and 48.0%) for SC, CT, IUI+COS and IVF-ET respectively. Using logistic regression, neither male factor nor group was significant for pregnancy. After hysteroscopic correction the reproductive outcome of patients who had infertility and RPL with a subseptate uterus and those with arcuate uterine anomaly is similar. Surgical correction of such anomalies may improve reproductive potential in patients with RPL who present with such anomalies.

Background: This retrospective study compares the safety and efficacy of temporary ovarian suspension (TOS) to the anterior abdominal wall using absorbable versus non-absorbable suture after operative laparoscopy to elevate the ovaries away from the ovarian fossa to reduce postoperative adhesion development. Methods: Patients (n=152) underwent TOS to the anterior abdominal wall at the conclusion of surgery between 1998 and 2017. One hundred forty-two patients underwent operative laparoscopy for advanced stages of endometriosis (93.4%) and 10 patients for other indications (6.6%). In 78 patients the ovaries were suspended to the fascia using absorbable 3-0 plain catgut sutures (Group 1). In 74 earlier patients non-absorbable 3-0 mono-filamentous nylon was used to suspend the ovaries to the anterior abdominal (Group 2). Results: In both groups there was no reported incidence of any major intra-operative complications such as bleeding, or late complications such as infection, hematoma or bowel herniation through the suture loop and its sequalae (bowel obstruction or strangulation). In all patients in both groups the ovaries were present in its anatomical location on transvaginal ultrasound scan, one week after surgery following absorption or removal of the TOS suture. There was no significant difference in clinical pregnancy (34.3% vs 44.2%) and delivery (31.3% vs 36.5%) rates in patients who conceived with non-IVF methods between Group 1 and Group 2 respectively. Conclusions: TOS to the anterior abdominal wall, using absorbable or non-absorbable sutures, in an attempt to reduce postoperative adhesion development between the ovary and ovarian fossa, is simple, safe, easy to learn, and has potential effectiveness.

To compare reproductive outcome in infertile patients after hysteroscopic division of incomplete uterine septum or arcuate uterine anomaly. Eight hundred thirty-two infertile patients who were found to have incomplete uterine septum (290 patients, Group 1) or arcuate uterine anomaly (542 patients, Group 2) on hysteroscopy between 1992 and 2016 were studied. At the time of hysteroscopy the type of uterine anomalies according to ASRM classification (Class IV b or Class V) was documented and its mid fundal length was measured using the tip of a straight resectoscope loop. If the incomplete uterine septum or arcuate uterine anomaly was deemed clinically significant (mid fundal protrusion length ≥10 mm) it was divided at the same session. Depending on the underlying etiology couples were allowed to try to achieve pregnancy spontaneously (SC), with Clomid treatment (CT), intrauterine insemination after controlled ovarian stimulation (IUI+COS) or in-vitro fertilization- embryo transfer (IVF-ET). Follow-up was up to 3 years. Paired test and Chi-Square analysis were used for statistical analysis and logistic regression was used to further examine any statistical significant bivariate analysis involving pregnancy. Mean age in years was significantly lower in Group 1 compared to Group 2) respectively (p = 0.007). There was no significant difference in duration of infertility in years, day 3 FSH levels, and BMI in kg/m2 between the two groups. There was significantly higher incidence of primary infertility [p = 0.05], and endometriosis [p = 0.026], and significantly lower incidence of male factor infertility [p = 0.012] in Group 1 vs Group 2 respectively. There was no significant difference in the incidence of ovulatory disorders, tubal factor, and history of miscarriage between the two groups. There was a significantly higher clinical pregnancy (68.8% vs 57.5%), and delivery/ongoing pregnancy (60.0% vs 50.7%) rates in Group 1 compared to Group 2 (p = 0.002 and p = 0.011 respectively). There was no significant difference in miscarriage (11.1% vs 10.6%), ectopic (1.0% vs 0.6%), and multiple birth (27.5% vs 25.5%) rates between the two groups. There was significantly lower percentage of patients who conceived with IVF/ET and significantly higher percentage of patients who conceived spontaneously in Group 1 compared to Group 2 (p = 0.000). Using logistic regression, group and age were still significant factors in predicting pregnancy even when also considering primary infertility, endometriosis, and male factor infertility. After hysteroscopy correction the reproductive outcome of infertile patients with incomplete uterine septum is better than those with arcuate uterine anomaly. However, surgical correction of both such anomalies improves reproductive potential in infertile patients.

STUDY OBJECTIVE:To demonstrate a modified technique of temporary suspension of the ovary to the fascia of the anterior abdominal wall after operative laparoscopy for advanced stage-endometriosis to reduce postoperative adhesion formation.DESIGN:Video illustrating this modified technique of ovarian suspension (Canadian Task Force classification III).SETTING:A previous study described a technique of temporary suspension of the ovary to the abdominal wall using nylon suture [1]. Here we demonstrate a modification of this technique involving underwent temporary suspension of the right ovary, using dissolvable 3-0 plain catgut suture, after operative laparoscopy for advanced-stage endometriosis (American Society for Reproductive Medicine stage III classification).INTERVENTIONS:This patient underwent right ovariolysis for stage III endometriosis. A CO2 laser was used to evaporate spots of endometriosis on the surface of the ovary, ovarian fossa, and the wall of a small endometrioma. A 3-0 plain catgut suture was placed in the right ovarian ligament, and the needle was cut and removed from the peritoneal cavity. The ends of the sutures were brought out of the peritoneal cavity through a 3-mm skin incision using an Endo Close device (Medtronic, Minneapolis, Minnesota). The suture was tied over the fascia while allowing CO2 gas out of the peritoneal cavity, to ensure that the suture remained under tension and the ovary was well suspended without touching the abdominal wall. The suture was used to elevate the ovary away from the ovarian fossa, to avoid recurrence of adhesions between it and the ovary. Postoperatively the patient did well and was discharged home on oral pain medication on the same day of surgery. No postoperative complications related to the suspension procedure were reported. The patient had an uneventful recovery.CONCLUSION:This modified approach of temporary ovarian suspension to the fascia of the anterior abdominal wall appears to be simple, safe, and easy to learn.

To illustrate the surgical technique of hysteroscopic resection of small uterine fibroids found embedded at the base of a significant arcuate uterine anomaly and incomplete uterine septum during hysteroscopic division of such anomalies. In this video we demonstrate two cases of patients that were each undergoing infertility workup. These patients were found to have uterine anomalies along with small uterine fibroids that were embedded in the uterine anomalies. The video shows the surgical management of septoplasty as well as removal of the fibroids hysteroscopically in the same setting. Post operatively patient in case one saline infusion hysterogram was normal and patient conceived after in vitro fertilization. Patient in case two post operatively had a slight residual septum and conceived spontaneously. We believe the detection and surgical removal of such fibroids may improve reproductive potential in such patients.

During in-vitro fertilization and embryo transfer (IVF-ET) meticulous and atraumatic ET procedure is essential for a successful outcome. When a problematic cervix is identified based on a difficult mock catheter trial, or in the presence of history of previous C-section, pelvic adhesions, uterine fibroids, large Nabothian follicles, a plan of action needs to be formulated. The aim of this study is to determine the effectiveness of placing a cervical suture on the anterior lip of the cervix on day of oocyte retrieval in facilitating ET procedure in patients in whom a difficult ET was expected. Retrospective study This study included all patients (# 1367) who underwent fresh non donor IVF-ET treatment and ended in ET (January 2006 to September 2016). Patients were divided into two groups. Group 1 consisted of 323 patients who had a cervical suture (2-0 vicryl) placed on the anterior lip of the cervix on the day of retrieval after a difficult mock trial. Group 2 included 1042 patients who did not receive a cervical suture prior to the ET after an easy mock trial. All ET were performed under trans-abdominal ultrasound scan (TA US) guidance using a soft embryo transfer catheter. The ease of ET procedure was reported and the ease by which the drop of air next to the drop of culture media moved in the endometrial cavity was also reported. If the drop moved easily away from the tip of the catheter it was reported as bullet sign. Pregnancy outcome was also reported. The mean age (yrs) in Group 1 (33.4 + 4.9) was significantly lower than Group 2 (34.7 + 5.2) [p<0.01]. Overall, there were no significant differences in key controlled ovarian stimulation parameters and embryology data between the two groups. There were no significant differences in percentage of patients who had very easy TA US guided ET procedure between Group 1 (93.1%) and Group 2 (96.2%). In addition, there were no significant differences in percentage of patients who had bullet sign on TA US guided ET between Group 1 (87.8%) and Group 2 (91.7%). Furthermore, there were no significant differences in pregnancy and miscarriage rates between Group 1(50.0% & 6.75%) and Group 2 (52% & 9.1%). Our data suggest that in patients in whom difficult ET is anticipated, placing a suture on the anterior lip of the cervix on day of oocyte retrieval makes ET procedure easy and in turn may help in improving pregnancy outcome. We suggest liberal use of suture on the anterior lip of the cervix when indicated.

Study ObjectiveTo determine the incidence of postoperative ascending infection without antibiotics with the use of a pediatric Foley catheter (PFC) after operative hysteroscopy for intrauterine pathology.DesignRetrospective case series (Canadian Task Force classification III).SettingUniversity-affiliated outpatient medical center.PatientsPatients who underwent operative hysteroscopy for uterine septum, arcuate uterine anomaly, or multiple submucosal myomas between 1992 and 2015.InterventionsIn all patients, a PFC was placed in the endometrial cavity at the conclusion of operative hysteroscopy and left in place for 7 days to reduce intrauterine adhesion formation.Measurements and Main ResultsA total of 1010 patients who underwent operative hysteroscopy for uterine septum (n = 479), arcuate uterine anomaly (n = 483), or multiple submucosal myomas (n = 48) were studied. All patients presented with infertility, recurrent pregnancy loss, or excessive uterine bleeding (in patients with submucous myomas). In all patients, a PFC was placed at the conclusion of the procedure and left in place for 7 days. An 8Fr PFC was used after hysteroscopic division of uterine septum or arcuate uterine anomaly, and a 10Fr PFC was used after hysteroscopic myomectomy. Patients with a history of pelvic inflammatory disease were excluded. Following PFC placement, patients were prescribed estrogen for 6 weeks and progestogen for the last 10 days of the estrogen course. No prophylactic antibiotic therapy was provided. All patients were discharged to home on the same day. Postoperative pain was well controlled with oral pain medication in 98.5% of the patients. There were no reported postoperative infections, and all patients had an uneventful recovery.ConclusionIn 1010 consecutive operative hysteroscopies followed by temporary (7-day) PFC placement, no clinically significant uterine infection was observed.

Endometrioma are benign, estrogen dependent ovarian cysts that are found in 17-44% of women with advanced endometriosis during reproductive years of life. Very few cases have been have been reported where the endometrioma was found outside the ovary. A recent publication by Trehan described the laparoscopic management of endometrioma of the broad ligament. Only two other cases of endometrioma have been described outside the ovaries in the literature. In this report we describe the laparoscopic management of what we believe is the first reported case of myometrium endometioma after failure of transvaginal ultrasound to identify the precise location of the cyst. Patient is a 30-year-old white female G0 with history of endometriosis. After imaging workup, a 32 × 24 mm left adnexal mass was noted on transvaginal ultrasound. The mass appeared to be cystic with and echogenic, increasing the suspicion for a dermoid cyst. Patient opted to undergo diagnostic laparoscopy where the rare finding of myometrium endometrioma was discovered. The cyst was excised, drained and the cyst wall dissected. The cavity gap was repaired using a 3-layer closure. This report suggests that endometrioma can be present within the myometrium and provides further evidence suggesting the etiology of endometriomas can be explained by methods other than retrograde menstruation.

INTRODUCTION: Patients with known uterine septum or arcuate uterine anomaly who had a successful live birth with placental location not on the septum and subsequently present with reproductive failure pose a difficult management decision. The aim of this study is to compare pregnancy outcomes in patients who had hysteroscopic correction of the uterine anomaly to those who did not in such group of patients. METHODS: This retrospective study included 67 patients who had a live birth and a diagnosis of uterine septum (complete [2.4%], incomplete [61.9%]), or arcuate uterine anomaly (35.7%), between 2005 and 2015. Subsequently 30 patients (44.8%) presented with secondary infertility, 6 patients (9%) presented with recurrent pregnancy loss (RPL), 3 patients (4.5%) presented with history of miscarriage, and 28 (41.8%) presented with secondary infertility and miscarriage or RPL. Forty-eight patients (71.6%) underwent hysteroscopic correction and 19 patients (28.4%) elected not to have surgery. RESULTS: Mean age was 32.4+4.3 years. Mean gestational age was 37.1+3.9 weeks. Of the 48 patients who underwent hysteroscopic correction, 34 conceived (70.8%). Of those, 31 delivered/ongoing (64.6%), and 3 miscarried (8.8%). Of the 19 patients who elected not to have surgery, 1 patient conceived (5.3%), and her pregnancy is ongoing (P<.001). CONCLUSION: Hysteroscopic correction of uterine septum or arcuate uterine anomaly significantly improves reproductive outcomes in patients who present with reproductive failure even after a previous successful live birth.

The prevalence of subtle uterine anomalies, such as, arcuate uterine anomalies and subtle uterine septum in infertile patients, varies in the literature (0.5% - 26%). During office hysteroscopy gynecologist usually avoid marked distention of the endometrial cavity to decrease patient discomfort. The combination of this and the small size of the hysteroscope used in office hysteroscopy may lead to less detection rate of such anomalies.

INTRODUCTION: The aim of this study is to determine placental location in pregnancy that ended in a live birth in patients with known uterine septum or arcuate uterine anomaly. METHODS: This retrospective study included sixty-seven patients who had a live birth and a diagnosis of uterine septum or arcuate uterine anomaly based on trans-vaginal 3D ultrasound scan (TV 3D US) with or without saline infusion sonohysterogram (SIH) between 2005 and 2015. Thirty patients (44.8%) presented with secondary infertility, 6 patients (9%) presented with recurrent pregnancy loss (RPL), 3 patients (4.5%) presented with history of miscarriage, and 28 (41.8%) presented with secondary infertility and miscarriage or RPL. RESULTS: Mean age was 32.4±4.3 years. Mean gestational age was 37.1±3.9 weeks. Placental location was not on the septum in 57 patients (85.1%); placental location was anterior in 29 patients (43.3%), posterior in 25 patients (37.3%), and lateral in 3 patients (4.5%). Eight patients (11.9%) had partial fundal location (fundal anterior in 6 patients [75%], and fundal posterior in 2 patients [25%]). Placental location was fundal in 2 patients (3%). In one of these patients the septum was found to be very vascular during hysteroscopy; the patient experienced vaginal bleeding through the pregnancy and delivered at 28 weeks. CONCLUSION: Our data support the long held theory that placental location in relation to uterine septum or arcuate uterine anomaly influence reproductive outcomes. Also, our data may explain the variable reproductive outcome of patients with such anomalies in the literature.

Solitary tubal diverticula are thin walled outpouchings of the fallopian tube. The wall of the diverticulum is deficient of the muscular layer. They have been associated with ectopic pregnancy, tubal infertility and endometriosis. Surgical correctixon of tubal diverticula has been associated with improved fertility outcomes.

To evaluate the reproductive outcome after hysteroscopic correction of subtle uterine septum in patients with unexplained RPL alone and those with additional Antiphospholipid syndrome (APS).