I think though the Ultrasound of pelvis and MRI can help in the Diagnosis,but still diagnostic Hysteroscopy and Laparoscopy gives definitive diagnosis and help in the managements of the patient of recurrent pregnancy losses.i have published an article on uterine septum misdiagnosed on hysterography.please view that also.its published in the International journal of Obstetric and Gyanecology.its in my researchgate publication list.thanks

I do believe that a transvaginal US examination (either 2D or 3D) is the best non-invasive way to diagnose this uterine malformation. Later on, you can confirm it by means of ambulatory hysteroscopy with the use of mini hysteroscope. It takes only a few minutes to complete this procedure in ambulatory settings.

The MRI investigation is far too expensive and we can not afford it, but it just seems that MRI has not major advantage over 2Dor 3D TVUS examination (cost-effectiveness) in diagnosis of uterine septi...

Hysterosonography is the best and cheap test to evaluate the endometrial cavity.

I completely agree with prof igor But. in the hand of experienced ultrasonographer, with 2D as well as 3D US the diagnosis could be very precise. Hysterosonography additionaly has a risk factors of invasive procedure, and in the same time the solution - resection, excision can not be performed. In my experience after 2D or 3D US, the procedure of choice is hysterorectoscopy. It represent an invasive procedure with the possibilities of optical confirmation of anatomical distortion or lesion presence eand in the same time the operative correction could be performed. MRI as imaging method is associated with elevated expences and the report (images) are dealed with personel (radiologist) not so familiar with the uterine pathology.

in my experience the images by magnetic resonance y the best technique for diagnosis

The best noninvasive method is 3D ultrasonography by an expert sonologist. An expert fertility specialist is the best sonologist who has the thorough knowledge about the architecture of the uterus. MRI is expensive and not superior to 3D USG. Sonohysterogram is not non invasive.

Like Prof Igor But and Heman Haller has pointed I believe transvaginal 2D and 3 D ultrasound imaging is the best noninvasive diagnostic modality for uterine malformations. It is very important to know and understand the embryogenesis to diagnose uterine malformations. MRI and Saline Hysterogram has no additional advantage over 3D transvaginal ultrasound. On the contrary MRI is an expensive luxury, the report takes time. Saline Hysterogram is an invasive investigation which needs to be performed during proliferative phase. Fertilirt Consultants who are experienced in ultrasound imaging of pelvis in their hands the diagnosis accurate, results are discussed with the patient straight away and the management planned fairly promptly. Secondly not forgetting the renal track anomalies transabdominal ultrasound is performed there and than on diagnosis of uterine malformation. 

Hysterosonography is the standard but it does involve inserting a catheter into the cervix so if you're going into such an effort then why not use outpatient hysteroscopy a 3 to 5 mm scope which would give you more information than a 2D x-ray.

The 3D TVS is an accurate means for diagnosis of uterine septum and differentiating it from bicornuate uterus

3D -2D is fastest

I do agree with prof Blumenfeld and the 

Just perform a 3D US on early follicular phase

I studied this problem:

http://www.jmig.org/article/S1553-4650(12)01274-5/pdf

My conclusions are follows:

"3D sonohysterography has identical the highest accuracy compared to hysteroscopy with laparoscopy. There was no significant difference in diagnostic value between

value between 3D US with 2D sonohysterography and 3D sonohysterography or between 2D US performed by expert and 3D US with 2D sonohysterography.

The 3D sonohysterography should be applied when the results of 3D US are equivocal. The 2D sonohysterography might serve as an alternative for the verification of 2D US results, which were found to depend on the operator’s experience, particularly if access to the 3D technique is restricted."

Hysteroscopy without laparoscopy is less accurate than ultrasound tools.

Important is also the classification and criteria, which the examiner uses; you can see it in my recent publications (Human Reprod 2014).

http://www.jmig.org/article/S1553-4650(12)01274-5/pdf

3D transvaginal ultrasound is, in right hands, the best way to make a diagnosis. Forget hysteroscopy because more invasive and also MRI because of the costs. 2D ultrasound is not enough 

are there new ways such as high frequency ultrasound to diagnose the. uterine septum?

in my opinion 3D ultrasound in luteal phase and MRI has the same accuracy in delineating the type of anomaly and are more reproducible than the combined lap/hyst.

more, the are able to quantify the degree of distortion in an objective way.

obviously, 3D US has an higher patient's compliance and reduced cost

I agree with Zupi about 2D US: it is good for screening but not enough for anomaly characterization.

may be US can not differentiate bicornus from septate uterus but MRI is possible to do that. in predicted cases,laparoscopy can do as well and if the uterus is septated, hysteroscopy at the same operation will be done.

Result of disscusion:

11/16 answers: 3D US is noninvaisive; accurate method

6/16 answers: MRI is too expensive, without increasing accuracy in comparision to 3D US

5/16 responders believe that 2D TVS is accurate and sufficient

4/16 answers: diagnostic hysteroscopy is needed

2/16 believe that 2D is insufficient (low accuracy)

only 2/16: answered that laparoscopy with hysteroscopy is needed to diagnosis

Consensus:

Currently 3D US is wide acceptable noninvasive accurate reference standard for differentiation between septate and bicornuate uterus.

There may be appropriate for future consensus:

Nowadays performing the MRI in differentiation between septate and bicornuate uterus is not justified due to high costs, and laparoscopy with hysteroscopy due to a high invasiveness.

If you are interested in topic of diagnostics of the septate uterus and other malformations please read my recent paper (Human Reprod; 22 Dec 2014) about the risks of overdiagnosis and overtreatment of septate uterus associated with the ESHRE–ESGE criteria.

http://humrep.oxfordjournals.org/content/early/2014/12/22/humrep.deu344.full.pdf+html

http://humrep.oxfordjournals.org/content/early/2014/12/22/humrep.deu344.full.pdf+html

Dear Artur thank you for your kind submission. I'll look at it. I wish Merry Christmas again and a Happy New Year. Francesco

Thank you, Francesco. Wishing you and all debaters the joys of the holday season and a Happy New Year. Artur

Dear All,

Core message from our new study (Fertil Steril 2015) about 3D US, ESHRE-ESGE, ASRM classifications and septate uterus:

"The ESHRE-ESGE classification showed insufficient reliability for clinical use (κ < 0.90), especially in the diagnosis of septate uterus. Disagreement between raters may be lowered using simple morphometric criteria complementary to the ASRM classification."

Read more:

https://www.researchgate.net/publication/279967017

Best regards,

Artur

Article Reliability of the European Society of Human Reproduction an...

with both techniques is possible to obtain very good images of both defects, from my personal point of view the fundus must be evaluated , the 3D images are great and 4D ultrasound and MRI are very good too.

i send to you some images 

best regards

Dear All,

Because 3D ultrasound is currently the reference and non-invasive diagnostic tool for recognition of uterine septum and other congenital uterine malformations the most important thing was to define the gold standard criteria.

All previously suggested criteria, including recent ESHRE-ESGE and ASRM were totally arbitrary.

Please read the CUME (Congenital Uterine Malformations by Experts) reference standard - the newly suggested definition for septate uterus developed based on reliability/agreement/diagnostic accuracy study and 15 top experts' opinions.

Article Congenital Uterine Malformation by Experts (CUME): better cr...

Best wishes,

Artur