Differential diagnosis of septate and bicornuate uterus by sonohysterography eliminates the need for laparoscopy

Objective: To determine whether sonohysterography can differentiate septate from bicornuate uterus. Design: Prospective study. Setting: Outpatient infertility clinic of a university hospital. Patient(s): Twenty patients with history of recurrent pregnancy loss and hysterosalpingographic diagnosis of septate or bicornuate uterus. Intervention(s): Sonohysterography was done in all patients. Laparoscopy was performed to confirm diagnosis in 10 patients and was not done in 10 patients. All patients with septate uterus underwent hysteroscopic metroplasty; simultaneous laparoscopy was done in women who had diagnostic laparoscopy. Abdominal metroplasty was performed in patients with bicornuate uterus. Main Outcome Measure(s): Shape of the uterine cavity after surgery and pregnancy outcome. Result(s): The shape of the uterine cavity was normal in seven cases in each group and almost normal in six other patients after surgery. There were two pregnancy losses after metroplasty, one in a woman who had laparoscopy and one in a woman who did not have laparoscopy. One case of bicornuate uterus occurred in each group. Conclusion(s): Sonohysterography can differentiate septate and bicornuate uterus and may eliminate the need for laparoscopy to diagnose these uterine anomalies.