A Possible Uterine Septum on HSG: Why Another Scan?

If a report says “possible septum,” being asked to have another test may leave you wondering what the first one established. Ask your clinician to separate the finding from the question that remains unanswered.

Does an HSG confirm a uterine septum?

Accurate differentiation of uterine developmental differences requires seeing both the inner and outer contours. HSG does not show the external contour, so it has low diagnostic accuracy for distinguishing a septate uterus from a bicornuate uterus. Hysteroscopy alone also cannot distinguish these two.¹

A useful question is: “Which part of my anatomy have we seen, and which part still needs to be assessed?” Ask the clinician to show you the finding on your report or draw the distinction they are considering.

What might a further scan add?

ASRM recommends three-dimensional transvaginal ultrasound, with or without saline infusion, as the first-line noninvasive tool for assessing uterine shape. MRI and other methods may also be useful.¹

Ask which test is being proposed for you and why. Request an explanation of how it is performed, its preparation instructions and the choices available if you find intimate examinations difficult. Tell the team about those concerns before the appointment.

How certain is the interpretation?

The guideline notes that diagnostic studies have small samples from selected centers and that interpretation depends on the reader’s experience. When a septum diagnosis remains unclear, consultation with a clinician experienced in uterine developmental differences may help.¹

You can ask: “How confident are you in this interpretation? Would review by someone with experience in these findings change what we do next?”

What should I leave the discussion knowing?

Write down the current finding, what the proposed test is meant to clarify, and who will explain the result. If you have earlier images or reports, ask how to make them available for comparison.

Before a next step is booked, ask: “What decision will this result help us make? When will we review it, and which questions about my own circumstances should we discuss then?”

Down There, Decoded includes a See script for appointments and a Down-There Log. Use the appointment script to organize the words you want to use with your clinician; the imaging findings need clinical interpretation.