How can I boost fertility in PCOS and Septate Uterus Didelphys?

Dear Professor Winston,

I have a septate didelphys uterus. I also have PCOS. I have had 1 child this year after many miscarriages and taking a while to conceive. I had IVF once that ended in miscarriage. I would like a 2nd child. I had an emergency C-section prem baby at 35wks 3 days. I have anemi and coeliac disease.

Also recently had bloods stated low oestrogen level. G.p won’t refer to gynae. Also when have intercourse semen seems to all leak out. Had vaginal part septate removed but have thick septate in uterus.
Any ideas of further tests require or medicine to boost fertility. Will be 40 next year.


Dear I.,

Providing your FSH levels and your AMH level suggest that you have enough eggs in the ovaries, I would be inclined to recommend a referral to gynaecologist who is experienced in dealing with abnormalities of the uterus. If you do have a thick septum in uterine cavity, its removal or division should increase your chance of a normal pregnancy and decrease the chance of further miscarriages. But in order to make an assessment of whether you are suitable for surgery, I would strongly recommend an HSG (womb x-ray) and possibly a telescope inspection of the uterus too (an hysteroscopy). Clearly there should also be an assessment that there is sufficient ovarian reserve (based on the hormone results) and possibly a pelvic ultrasound. Although some surgeons may also recommend an MRI scan, this expensive test is seldom needed to arrive at a decision. The precise nature of the operative procedure will depend on how much of a septum there is and whether the uterus is entirely split into two separate cavities. In my experience of a large number of cases like yours, this kind of surgery on the uterus is often successful and avoids the need for IVF. Clearly, and in any case, repeatedly putting embryos back into an abnormal uterus (which abnormality is also the cause of the infertility) does not make a lot of sense.

My best wishes,

Robert Winston