Fw: Is an HSG alone good enough for a diagnosis?

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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

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