Lizbeth's Story:
Complete septum

I started out with a couple of infertility diagnoses, one of them being polycystic ovarian syndrome. Male factor was another. I have had perhaps four miscarriages, possibly more, most of them before six weeks. Finally, in August of 1999, I got pregnant and stayed pregnant beyond 6 weeks. I began to feel very hopeful until Christmas Eve, 1999, when I suddenly started to have contractions. In brief, I lost a boy baby at 19 weeks, LMP.

It sort of looked as though I had an incompetent cervix, although some of the signs were mixed. For one thing, I had no reason to suspect that I would ever have trouble with a weak cervix. And labor lasted a total of 22 hours, which is rather long for a case of genuine IC. However, the membranes slipped through the cervix before the contractions began.

Now we know that my cervix was forced open by the pregnancy itself rather than any inherent weakness. Baby ran out of room. Nine months after I lost the baby, I asked my doctor for a hysterosalpingogram (HSG), and that is when my broad, long septum showed up. (Click here for a spot image from that HSG) I later learned that my baby had almost no chance of making it to a viable age, not with that severe a split.

To figure out whether I had a septate or a bicornuate uterus, I had some ultrasound imaging done. Since the outer contour of the uterus was found to be smooth, my uterus was declared septate.

My gynecologist told me that he had not done many septum resections, so I looked elsewhere for a surgeon. Dr. Gary Berger (co-author of the The Couples' Guide to Fertility) in Chapel Hill, NC, performed the operation.

The surgery, a simultaneous laparoscopy and hysteroscopy, went well, although a minor complication arose: a tiny, bloodless midline perforation of the uterus. A perforation could be problematic if large or undetected, which is why they recommend the laparoscopy at the same time. The laparoscopic view also showed an extremely slight dimple in the middle of the outer dome of my uterus--too slight to have been detected by US, and too slight to change the classification of my uterus from septate.

I felt fine within a few days. Right now I am waiting for a follow-up HSG to see if I'm ready to try to conceive again. I will post the results here.

UPDATE: The HSG shows residual septum and an adhesion in the lower segment of the uterus. I have scheduled a repeat septoplasty for March 21, 2001. Although I could carry a baby in the cavity I now have, it is best to make it as normal as possible; I don't want to risk losing another baby.

UPDATE: the septoplasty, a very slight one, done through hysteroscopy alone, went very well and the surgeon says my uterine cavity looked normal in size, shape and smoothness at the end of the procedure, and there was never any adhesion--that was just a trick of the HSG. I will post images from my third HSG here when it is done next month, and make a note here when I do conceive again, if I do.

I do have some reason to worry about incompetent cervix if I get pregnant again, so I will be seeking some expert opinions.