Missed Until Found: Diagnosis and Hysteroscopic Management of a Uterine Septum in a Woman With Primary Infertility.

Congenital uterine anomalies are an important yet frequently overlooked cause of female infertility, with a septate uterus representing the most common developmental anomaly of the uterine cavity. Although some affected women remain asymptomatic, others present with infertility, recurrent pregnancy loss, or adverse obstetric outcomes, making early recognition essential for appropriate management. We report the case of a 26-year-old nulligravid woman from Azerbaijan who presented with primary infertility of three years' duration despite regular menstrual cycles and an otherwise unremarkable infertility evaluation. Transvaginal ultrasonography followed by confirmatory imaging demonstrated a uterine septum as the underlying anatomical abnormality. After comprehensive counseling regarding available treatment options, the patient underwent successful hysteroscopic septum resection. The procedure was completed without intraoperative or postoperative complications, and follow-up evaluation confirmed restoration of a normal uterine cavity. The patient recovered well and was advised regarding future conception planning with continued reproductive follow-up. This case highlights the importance of incorporating detailed uterine cavity assessment into the routine evaluation of women with unexplained primary infertility. It also demonstrates the effectiveness of hysteroscopic septum resection as a safe, minimally invasive procedure for restoring normal uterine anatomy. Increased clinical awareness, timely diagnosis, and access to advanced imaging modalities are essential to facilitate early intervention and optimize reproductive outcomes, particularly in resource-variable healthcare settings where congenital uterine anomalies may remain underdiagnosed.