Uzm. Dr. Ertan Özen
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- 36+years exp.
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Gynaecological Procedures
Hysteroscopic septoplasty
What a uterine septum is and how hysteroscopic septoplasty divides it from inside the womb, what the evidence says about miscarriage, preterm birth and fertility, how a septum is told apart from a bicornuate uterus, approximate costs in Turkey against the UK, US and Germany, the operation step by step, recovery, waiting time before trying to conceive, risks and how to check a clinic.
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Prof. Dr. Zehra Neşe Kavak
GynaecologyVerified
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What is hysteroscopic septoplasty and what does it treat?
Hysteroscopic septoplasty (also called uterine septum resection or metroplasty) is an operation that removes or divides the wall of tissue that splits the inside of the womb in a septate uterus. A septate uterus is a congenital difference present from birth: the outside of the womb has a normal shape, but a band of fibrous or muscular tissue hangs down from the top into the cavity, partly or completely dividing it. The operation is done through the vagina and cervix with a hysteroscope, a thin camera, so there is no cut on the abdomen. Hospitals in Turkey carry out hysteroscopic septoplasty in gynaecology and fertility departments.
Most women with a septum have no symptoms and find out during a fertility work-up or after miscarriages. This guide explains how the diagnosis is made, whether the operation helps pregnancy outcomes, what it costs in Turkey compared with the UK, US and Germany, what recovery involves and the questions to ask. The wider list of procedures is in our gynaecology treatments in Turkey.
How is a uterine septum diagnosed, and is it the same as a bicornuate uterus?
No, and the difference decides the treatment. In a septate uterus the outer fundus (top) of the womb is smooth or only slightly indented, and the division is internal tissue that can be cut from inside. In a bicornuate uterus the womb itself is heart-shaped with two horns, and cutting inside does not help. A standard two-dimensional scan can miss the difference, so the diagnosis is confirmed with a three-dimensional ultrasound, a saline contrast scan (sonohysterography), or MRI. A hysterosalpingogram alone is not reliable for telling the two apart. Classification by the European societies of reproduction and gynaecological endoscopy (ESHRE and ESGE) describes the septum by length, which affects how the operation is planned.
A diagnostic look inside the womb, as described in our guide to hysteroscopy, is often the first step before the operation, and sometimes the septum is divided in the same sitting.
Does hysteroscopic septoplasty work for miscarriage and fertility?
This is the question with the most honest uncertainty. Observational studies link a septate uterus with a higher risk of first-trimester and second-trimester miscarriage and preterm birth, and many gynaecologists offer septoplasty for that reason. However, randomised trials so far, including a large Dutch study, did not show a clear difference in live birth rates between women who had the septum removed and women who waited. European reproductive societies therefore describe the evidence as limited and advise individual decisions: septum resection is most often considered after repeated pregnancy loss with no other explanation, or when a septum is found before fertility treatment and the woman and her doctor decide to proceed.
What is not in doubt is that the operation removes the septum safely in experienced hands, and that a normal-shaped cavity is the intended result. No clinic can promise a pregnancy or a live birth, and a good one will say that at the consultation.
Hysteroscopic septoplasty cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for the operation and a short hospital stay, not hospital quotes. Each hospital confirms its price in writing after seeing your imaging.
| Country | Approximate cost range |
|---|---|
| Turkey | €1,200 – €3,500 |
| United Kingdom | €2,500 – €6,000 |
| United States | €4,000 – €12,000 |
| Germany | €2,500 – €6,000 |
What changes the price: the length and width of the septum, whether the surgeon uses scissors or an electrical loop, whether ultrasound or laparoscopic guidance is used during the operation, the type of anaesthesia, a night in hospital and any follow-up hysteroscopy to check the cavity. Ask the coordinator whether the post-operative hormone treatment and the check-up scan are included; they are billed separately in some packages.
How is the septum removed, step by step?
The operation is usually done under general anaesthesia or deep sedation and takes 20 to 45 minutes.
- Preparation. The cervix is gently widened and saline fills the cavity so that both sides of the septum can be seen.
- Division. The surgeon cuts the septum along its midline with fine scissors or a small electrode, working from the free edge towards the top, and stops when the two halves of the cavity merge and the tubal openings are seen on both sides.
- Guidance. An abdominal ultrasound or a laparoscope may be used at the same time to watch the thickness of the wall at the top of the womb, which lowers the risk of perforation when the septum is wide.
- Finish. The cavity is inspected, and in some units a balloon or a hormone course is used to discourage scar tissue.
The surgeon does not cut into the muscle wall; dividing the septum slowly and conservatively is the safer approach.
Septum resection, watchful waiting or abdominal surgery?
| Option | Suited to | Typical limits |
|---|---|---|
| Hysteroscopic septoplasty | Confirmed septate uterus with pregnancy loss or before fertility treatment | Benefit for live birth is not proven in trials |
| Watchful waiting | Septum found by chance, no pregnancy problems | Miscarriage and preterm birth risks remain |
| Abdominal metroplasty (open surgery) | Rarely; some bicornuate or complex malformations | Major surgery, scarring, Caesarean delivery needed |
If a polyp or fibroid is found at the same time, it can usually be removed in the same operation, as with hysteroscopic polypectomy or hysteroscopic myomectomy.
Who is a good candidate, and who is not?
Good candidates are women with a septate uterus confirmed on 3D ultrasound or MRI who have had two or more pregnancy losses, a late miscarriage or a preterm birth, or who are about to start IVF with a long septum and want to proceed after counselling. You are not a candidate if the uterus is bicornuate or has another malformation where cutting inside does not help, if there is an active pelvic infection, if you are pregnant, or if a short septum in a woman with no history is often left alone. Women with a double cervix or a vaginal septum may need a different plan, and a full report of your imaging is the first thing a surgeon will ask for.
Recovery after hysteroscopic septoplasty and when to try for a baby
Most women go home the same day or after one night. You can expect mild cramps for one or two days and light bleeding or brown discharge for up to two weeks. Many people return to desk work within three to five days. Sex, tampons, baths and swimming are usually paused for about two weeks. Some surgeons prescribe oestrogen for a few weeks to help the lining heal over the cut area, and a check hysteroscopy or scan one to three months later confirms the shape of the cavity. Advice varies on when to try to conceive: typically one to three months after the cavity has healed, but follow your surgeon's instructions. Pregnancies after septum resection are usually monitored more closely.
For travel, plan three to four nights: pre-operative checks, the operation, and a review before flying.
Risks and complications of hysteroscopic septoplasty
Complications are uncommon but real. They include bleeding, infection, a hole in the wall of the womb (perforation), overload of the distension fluid, injury to the cervix and the formation of scar tissue inside the cavity (adhesions, sometimes called Asherman syndrome), which can cause light periods or infertility and may need a second hysteroscopy. A small stump of septum can be left behind if the division is cautious, and a second look may be needed. RCOG and ESHRE patient information discuss these in detail; ask which of them your surgeon has seen and how they are handled. If you become pregnant afterwards, tell your obstetrician about the operation.
How to choose a surgeon and hospital, and what to ask
Look for a gynaecologist with regular experience of hysteroscopic surgery for congenital uterine anomalies, a hospital with 3D ultrasound and anaesthesia support, and a plan to review you after the operation. Red flags include a diagnosis based on a basic scan alone, advice that septoplasty is certain to lead to pregnancy, quotes without a breakdown and pressure to pay a deposit before your imaging is reviewed. Read how our process works and send your scans through the free quote page.
Questions worth asking:
- How was my septum measured and has a bicornuate uterus been excluded?
- Will you use ultrasound or laparoscopic guidance?
- Do you prescribe hormones or arrange a check hysteroscopy?
- When should I try to conceive afterwards?
- How many hysteroscopic septum resections do you perform each year?
Hospitals with Gynaecology in Turkey
Frequently asked questions
It is an operation that cuts away a uterine septum, a band of tissue that divides the cavity of the womb. The surgeon works through the cervix with a hysteroscope, so there is no abdominal incision.
The septum is linked with miscarriage and preterm birth in observational studies, but randomised trials have not shown a clear gain in live birth rates. The decision is individual and best made with a fertility specialist.
Approximate ranges are €1,200 to €3,500 in Turkey against about €2,500 to €6,000 in the UK. The price depends on the size of the septum, the guidance method, anaesthesia and the hospital stay.
A septate uterus has a normal outer shape with an internal dividing wall, which can be cut. A bicornuate uterus is heart-shaped on the outside, and hysteroscopic cutting does not correct it. 3D ultrasound or MRI tells them apart.
Most women go home the same day, have cramps for a day or two and light bleeding for up to two weeks. Many return to desk work in three to five days. A check scan follows within a few months.
Many surgeons advise waiting one to three months for the cavity to heal, and some prescribe oestrogen and a check hysteroscopy first. Follow the timing your own surgeon gives.
It is usually done under general anaesthesia or deep sedation, so you feel nothing during it. Afterwards period-like cramps are common and usually settle with simple painkillers within a couple of days.
Risks include bleeding, infection, perforation of the womb wall, fluid overload and scar tissue inside the cavity. A residual septum may need a second look. These are uncommon in experienced hands.
A completely removed septum does not grow back, but a small stump can remain and may be divided later. A check hysteroscopy or 3D scan after healing confirms the result.
Three to four nights is typical: pre-operative checks, the operation and a review before the flight. A longer stay may be advised if a second procedure is combined.
Patient stories