This chapter presents a comprehensive review of the reproductive problems that could be associated with uterine septum. The classification of uterine anomalies divides the uterine septum into complete (septate) or partial (subseptate) groups, according to whether the septum approaches the internal os or not, respectively. Although surgery (hysteroscopy, alone or with laparoscopy) constitutes the gold standard for the diagnosis of uterine septum, various imaging tools including hysterosalpingography (HSG), ultrasonography, and magnetic resonance imaging (MRI) have great value in the diagnosis with high level of accuracy. The hysteroscopic approach for surgical resection of uterine septum is a safe and effective approach. While generally it is an operator preference whether to utilize ablative energy, for example, electrical diathermy or laser, or to utilize sharp scissors without energy, the outcome of treatment is comparable as regards complication and reproductive performance after surgery.