The impact of uterine septum on reproductive outcome—half-empty or half-full?

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Few clinical dilemmas in reproductive medicine have persisted over decades with little progress toward resolution. The impact of a uterine septum on reproductive outcome is one of the most important and, regrettably, one of the thorniest dilemmas, for a variety of reasons so familiar to us. First, our ability to diagnose anomalies by combinations of imaging and endoscopy has been possible for only a short time. Indeed, not all that many years ago, the literature included a number of studies that almost certainly overstated the prevalence and impact of bicornuate uteri that were more likely to have been septate (1).