Variations in Hysteroscopic Appearance of Partial Septate Uteri and Arcuate Uteri
Recommended Citation
Daviskiba S, Abuzeid MI. Variations in Hysteroscopic Appearance of Partial Septate Uteri and Arcuate Uteri. Fertil Steril 2024; 122(4):e436.
Document Type
Conference Proceeding
Publication Date
10-1-2024
Publication Title
Fertil Steril
Abstract
OBJECTIVE: To provide hysteroscopic examples of arcuate uteri and partial septate uteri to supplement classification diagrams and to emphasize "gray area" of the current classification systems that are not inclusive of all patients. METHODOLOGY: Video examples are of patients that underwent diagnostic hysteroscopy as part of a workup for infertility and recurrent pregnancy loss. Hysteroscopy was performed under general anesthesia to ensure that adequate cavity distension and visualization could be performed, which may otherwise be limited by patient discomfort during in-office hysteroscopy. An ACMI 0°or 12°7mm hysteroscope lens (Division of Olympus; Maple Grove, MN, USA) was used for all cases. Normal saline was used as initial distension media, unless septum division was being performed, in which case it was switched to 1.5% glycine. A straight resectoscope loop electrode and hysteroscopic scissors were used for measurement and division of the septum. Using the hysteroscopic uterine palpator as a reference, standardized measurements of the instruments were established to allow for indirect and direct measurements of the septum length. Indirect measurement was obtained by measuring from the level of the tubal ostia to the apex using the instruments above. Using Pythagorean's theorem, indirect measurement was multiplied by 60% to get an estimate of the septum length. Indirect measurement was performed after septum incision by measuring from the apex (starting point of incision) to the base of the incised septum. CONCLUSIONS: There is a wide variety of hysteroscopic presentations of the partial septate uterus, with many patients not aligning with existing classification. ASRM defines a lower proportion of septate uteri as compared to the ESHRE-ESGE & CUME, leaving a large proportion of patients in the gray-zone (neither diagnosed as normal/arcuate nor partial septate uteri). With this uncertainty in diagnostic classification, current ASRM guidelines may exclude patients who could potentially benefit from intervention. As recent committee opinion has established, septum incision can be beneficial to patients with recurrent pregnancy loss. IMPACT STATEMENT: While there is no universally accepted definition to differentiate arcuate from partial septate uteri, adopting criteria focused on fundal indentation depth rather than apex angle may be more inclusive. Ultimately, additional work is needed for education of generalists and subspecialists on the various hysteroscopic appearances to improve diagnosis and steer potential treatment.
Volume
122
Issue
4
First Page
e436
