<p>The current classification for congenital malformations by the American Society of Reproductive Medicine (ASRM) largely aligns with the German classification. While most congenital asymptomatic malformations do not require surgical intervention, the data on uterine septus remain inconclusive. There is no definitive surgical indication for asymptomatic uterine septum; however, septal resection may be indicated in cases of recurrent spontaneous abortions. For congenital malformations accompanied by hematometra, surgical intervention is indicated to alleviate symptoms. Accurate diagnosis with proper classification, combined with an individualized risk–benefit assessment in collaboration with the patient, is essential.</p>