The role of diagnostic hysteroscopy in diagnosis of incomplete uterine septum/significant arcuate uterine anomaly in infertile patients in the era of transvaginal 3D ultrasound scan

Abstract

Background:To determine the accuracy of measurement of internal indentation length on transvaginal 3D ultrasound scan (TV 3D US) in detecting patients with an incomplete uterine septum (IUS) or a significant arcuate uterine anomaly (AUA) based on the actual length as measured on diagnostic hysteroscopy. We compared the mean internal indentation length on TV 3D US and on diagnostic hysteroscopy in patients with IUS or a significant AUA. Results: This is a retrospective study of 546 patients who were found to have IUS (134) or significant AUA (412) on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The mean internal indentation length measured in millimeter on hysteroscopy was significantly higher than the mean internal indentation length measured on TV 3D US in patients with IUS (16.7 + 5.5 vs 5.5 + 4.2; P < 0.001), in patients with significant AUA (12.9 + 2.8 vs 3.9 + 4.6; P < 0.001), and in the overall population (13.8 + 4.0 vs 4.3 + 4.5; P < 0.001). The same findings were obtained when the comparison was limited to patients who had moderate significant internal indentation length (10-14 mm) and those with significant internal indentation length (15-25 mm). Conclusion: Data in this study suggests that the mean internal indentation length in patients with IUS or AUA can be underestimated on TV 3D US. A diagnostic hysteroscopy is the only gold standard to make the correct diagnosis in these patients.

Hysteroscopy as a Primary Tool in Exploration and Treatment of Infertility: Single Center Experience in Western Romania

“…Regarding the uterine septum, even if this pathology is not a primary factor for infertility, approximately 40% of its patients have infertility, obstetric complications and an increased incidence of recurrent miscarriages [15]. The prevalence of uterine septum in infertile women varies, but is estimated to be 3.9%, similar to that in our study [16].…”

Limitations of imaging screening tests in the detection of incomplete uterine septum or arcuate uterine anomaly

“…This is similar to other recently published reports. 14,15 In addition, the data suggest that both HSG and TV 2D US have an unacceptable failure rate in detecting such anomalies. Other studies suggested a high failure rate of HSG in detecting such anomalies.…”

“…16 It is imperative to indicate that TV 3D US is still an essential component for the diagnosis of congenital uterine anomalies in infertility and recurrent pregnancy loss patients. [14][15][16][17]20,21 This is because TV 3D US can accurately assess the external uterine contour, diagnose common concomitant gynecological conditions such as uterine fibroids, and is noninvasive in nature. 11 Many studies showed TV 3D US to have a great positive predictive value as high as 99.3% in detecting congenital uterine anomalies.…”

“…The IILFM was measured using the straight resectoscope loop electrode of the ACMI hysteroscope as previously described (Figure 1a-c). 14,15 TV 2D US and TV 3D US were performed as previously described. [13][14][15] The diagnosis of IUS or significant AUA was suspected on HSG if a significant mid fundal protrusion was detected (Figure 2a,b).…”

“…14,15 TV 2D US and TV 3D US were performed as previously described. [13][14][15] The diagnosis of IUS or significant AUA was suspected on HSG if a significant mid fundal protrusion was detected (Figure 2a,b). The diagnosis of IUS or significant AUA was suspected on TV 2D US if endometrial separation was detected in a transverse plane in the upper uterine segment (Figure 3).…”