Mullerian ducts anomalies (MDA) stem from a defect in Mullerian ducts fusion on the median line or from an incomplete reabsorption of the septum originated from their fusion.
Prevalence has been estimated between 16% and 10% [1, 2], while incidence involves 1% of general population and 3% of women having multiple abortions or infertility [2].
The discovery of a genital organ malformation may be random, but these patients show a wide span of symptoms, such as sterility, primary amenorrhea, multiple abortions, severe dysmenorrhea, abdominal pain, dyspareunia.
One third of anomalies is characterized by septate uterus, one third bicornuate uterus, 10% by arcuate uterus, a ten percent by didelphys and unicornuate uterus and less than five percent by uterine aplasia according to the American Fertility Society Classification [3].
The most commonly used classifications of mullerian anomalies in clinical practice include the American Fertility Society Classification and the Classification according to ESHRE-ESGE that was developed in 2013 [4, 5]. Nowadays, MDA are diagnosed by non-invasive techniques such as Magnetic resonance or 3D transvaginal ultrasound (3D-TV US) [6]. Painstakingly, 3D-TV US allows the creation of three - dimensional images useful to study the uterine surface and the cavity and to calculate endometrial volume. In particular, rotational measurement of volume has become possible thanks to the introduction of Virtual Organ Computer-aided Analysis (VOCALª), which is an extension of 3D-VIEWª software (Kretz Technik, Zipf, Austria). With this new imaging program, the dataset can be rotated around a fixed axis through a number of rotation steps determined by the observer. There are four rotation angles to choose from: 30°, 15°, 9°and 6°, and because the entire dataset is rotated about 180°, it results that we can observe respectively 6, 12, 20 and 30 planes.
3d-TV US and Magnetic resonance are considered as gold standard for the diagnosis of MDA, but the ultrasound is the more cost-effective technique [7].
The most common MDA is the septate uterus, V-a type according to the American Fertility Society classifications and U2b class according to the ESHRE-ESGE classification. These septa are usually repaired by performing a metroplasty with various hysteroscopic techniques. Hysteroscopic metroplasty is considered today as the first therapeutic option for septate uterus because it offers several advantages: reduced hospitalization, decreased intra and post - surgical morbidity, less surgical pelvic adhesions risk and increased amount of vaginal deliveries [8].
There are several tools which have been successfully used for hysteroscopic metroplasty: forceps, operative hysteroscopy, unipolar or bipolar cauterization, laser (ND-Yag, argon, diodes laser) [9–14], but no RCTs have shown that a technique is better than another [6, 15]. The aim of our study was to evaluate the efficacy of hysteroscopic office technique using a diode laser and its efficacy to increase endometrial volume by comparing transvaginal 3D ultrasound endometrial volume of patients affected by septate uterus before and about 3 months after metroplasty.