Guest guest Posted May 21, 2002 Report Share Posted May 21, 2002 FAQ: Is an HSG alone good enough for a diagnosis? > 7. Is an HSG alone good enough for a diagnosis? > > First of all, in an infertility work-up, a hysterosalpingogram (HSG) should > be done to assess the presence of a two-chambered uterus, the depth of the > division, as well as tubal patency. But an HSG alone can not differentiate > between septate and bicornuate uterus. Misdiagnoses of BU by HSG are very > common. > > Other methods have better levels of reliability: > ? Transvaginal ultrasound is nearly 100% successful in detecting a bifid > uterus, but only 80% successful in differentiating between SU and BU. It > can be a helpful tool in the diagnostic process, but should not be relied > upon alone. > ? Three-dimensional ultrasound (3DUS), is 92% accurate in differentiation of > BU from SU, according to one 1997 study, but not widely available at the > time of this writing. It should not be relied upon alone, with an 8% margin > of error. > ? According to two studies done in 1994 and 1995, MRI can reliably > differentiate between BU from SU. More recent studies cast some doubt on > this. Proceed with caution after an MRI. > ? Concurrent laparoscopy and hysteroscopy are considered the " gold standard " > of BU/SU differentiation. This test is invasive, but if needed, corrective > hysteroscopic metroplasty can be done at the same time. > > " The bottom line still seems to be that with a simultaneous > laparoscopy/hysteroscopy, the diagnosis is the most accurate. The doctors > were not sure if I had a septate or bicornuate uterus after a HSG and also a > hysterosonogram. However, after the MRI they felt very confident that I have > a septate uterus. I brought my films with me to my high-risk ob and he also > felt that based on the MRI I have a septate uterus. Anyway, I guess I can't > know for sure but it seems the MRI is more accurate than an HSG. " > > " HSG is arguably the best way to show what's inside the uterus, shows the > exact contour of the cavity, and determines tubal patency, but absolutely > does not differentiate between BU and SU. (Some say that if the angle > between the horns is > 75°, then it is a likely BU, but this is also not > reliable, as many septa can be very, very wide.) " > > " After an HSG 8 years ago I was give the mistaken diagnosis of BU; only > after 2 miscarriages this year do I know now that I have a septum. (I had a > hysteroscopy that showed a large septum combined with US that showed the top > of my uterus does not have the characteristic dip associated with BU) > Septums are associated with high miscarriage rates and 2nd/3rd trimester > losses. Septums can be surgically removed. Surgery dramatically increases > the outcome for a live pregnancy. " > > > " HSG and hysteroscopy alone [ . . .] cannot really differentiate between BU > & SU. An MRI or very, very careful US might be able to tell. I had a US > diagnose me as SU where the HSG was inconclusive. However, the surgeon > wanted to do a laparoscopy on me, too, before he would cut. I agree with his > rationale. " > > " I was diagnosed with MRI after an ultrasound showed a possible uterine > anomaly. I also had a HSG, which showed UU, but the MRI confirmed it. " > > " I was told that it was impossible to tell from my HSG whether my uterus was > BU or septate, so an MRI was proposed. Then the doc learned that MRI is > frequently inconclusive with this sort of thing, and ordered an abdominal > and transvaginal ultrasound. The diagnosis of septate was made, then, on > evidence that there wasn't even a dimple on the outside of the fundus, much > less a division. Scanning the longitudinal cross section showed that. My > other option would have been to have a simultaneous > laparoscopy/hysteroscopy. As it turned out, that is what I did have, just to > back up the diagnosis and monitor the septoplasty surgery. " > > " I had an HSG, which was a horrible experience for me and was diagnosed with > a UU. I was devastated. I did a bunch of research, found a group of women > with UUs and just pretty much fell apart at the information I found. [ . . > . ] The doctor decided to do an MRI to confirm the diagnosis. Turns out I > have a BU. " > > " They told me I am BU based on the HSG alone, but I don't feel like they > have enough info to give an accurate dx. She said she will call me after the > radiologist reads the US films. I tried to talk to the US tech, but I know > they aren't supposed to tell you too much while they are scanning you. I > asked some questions while she was working on me and she showed me the 2 > horns. I was asking her if she could really tell how the fundus was shaped > (smooth or indented), and she said that it looked indented, but said that > the HSG would show more. I know that HSG cannot show the outside contour of > the uterus, but the medical community seems misinformed on this. " > > -- > Beth > SU > 2 metroplasties > > > > > > Quote Link to comment Share on other sites More sharing options...
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