1 Recommendations

Guidance

1.1 Current evidence on the safety of hysteroscopic metroplasty of a uterine septum for primary infertility includes some serious but rare complications. Current evidence on efficacy is inadequate in quantity and quality. Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

1.2 Clinicians wishing to undertake hysteroscopic metroplasty of a uterine septum for primary infertility should take the following actions:

Inform the clinical governance leads in their NHS trust.
Ensure that women understand the uncertainty about the procedure's efficacy and its risks and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all women having hysteroscopic metroplasty of a uterine septum for primary infertility (see section 7.1).

1.3 Patient selection and treatment should be done by a multidisciplinary team including specialists in reproductive medicine, uterine imaging and hysteroscopic surgery.

1.4 Clinicians undertaking hysteroscopic metroplasty of a uterine septum for primary infertility should be trained in hysteroscopic surgery in accordance with the Royal College of Obstetricians and Gynaecologists training module.

1.5 Further research should include clear documentation of patient selection and of all complications. Outcomes should include pregnancy rates, live birth rates and instances of preterm delivery. Comparative studies would be helpful. NICE may update the guidance on publication of further evidence.