Presentation
Primary infertility for one year.
Patient Data
The upper part of endometrial cavity is divided into two separate equal-sized cavities, with a single common lower part of endometrial cavity, and one cervix. The configuration is possible for bicrnuate uterus and septate uterus.
Both Fallopian tubes are of normal caliber with normal patency.
The uterus is of normal size. No myometrial lesions.
The upper endometrial cavity is divided into two stripes.
The intercornual distance averages 4 cm.
Minimal concave fundal contour (depth / fundal indentation = 3~4 mm), yet its apex doesn't get below a horizontal line connecting both tubal ostia and a distance less than 10 mm.
The endometrial septum (fundal indentation angel) has an acute angle at the central point ~ 66°.
The intercornual angel is measuring ~70°.
Size of partial uterine septum (depth of fundal indentation) > 1.5 cm in length.
Single cervix and common lower endometrial cavity.
Diagrams of the ASRM definitions of normal/arcuate, septate, and bicornuate uterus 4.
Normal/arcuate: depth from the interstitial line to the apex of the indentation <1 cm and angle of the indentation >90 degrees.
Septate: depth from the interstitial line to the apex of the indentation >1.5 cm and angle of the indentation <90 degrees.
Bicornuate: external fundal indentation >1 cm. Internal endometrial cavity is similar to a partial septate uterus.
Case Discussion
3D transvaginal ultrasound measurements are suggestive of partial septate uterus with 1.5 cm partial uterine septum, considered as type 5b Müllerian duct anomaly.
The ASRM system in a comparative study showed that it had sufficient reliability than ESHRE-ESGE system in the assessment of uterine septum 3.
The most common diagnostic dilemma encountered in assessment of Müllerian duct anomaly is inability to differentiate between a septate and bicornuate uterus. Correct differentiation is important because a septate uterus is surgically correctable and has a strong association with repeated miscarriage.
A combined bicornuate/septate configuration of the uterus has been described in which the external fundus has an indentation consistent with a bicornuate shape. Considering septate uterus requires fundal indentation less than 1 cm, with greater than 1 cm more consistent with bicornuate uterus 4.
Features supporting the diagnosis of partial septate uterus rather than bicornuate uterus, in this case, are:
- intercornual distance is not more than 4 cm and fundal cleft <1 cm 4
- fundal indentation angel is less than 90° (~66°)
- intercornual angel <75-105° (~70°)