The international agreement study on the diagnosis of the septate uterus at office hysteroscopy in infertile patients

The agreement on the hysteroscopic diagnosis of septate uterus was found to be poor. Clear definitions are needed to use hysteroscopy as a reliable screening tool for uterine cavity abnormalities.


Janine G. Smit, M.D., Jenneke C. Kasius, M.D., Ph.D., Marinus J.C. Eijkemans, Ph.D., Sebastiaan Veersema, M.D., Human M. Fatemi, M.D., Ph.D., Evert J.P. Santbrink van, M.D., Ph.D., Rudi Campo, M.D., Ph.D., Frank J.M. Broekmans, M.D., Ph.D.

Volume 99, Issue 7, Pages 2108-2113.e2, June 2013



To assess the international agreement on the hysteroscopic diagnosis of septate uterus.


Interobserver study.


Eight hysteroscopy recordings were put online on the website of the European Society of Gynaecological Endoscopy.


Asymptomatic, infertile women indicated for a first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycle.


Office hysteroscopy.

Main Outcome Measure(s):

The interobserver agreement on the uterine shape and necessity to correct the abnormality found.


Seventy-eight observers from 24 different countries assessed 8 hysteroscopy recordings. The interobserver agreement on uterine shape variations septate and arcuate was fair (intraclass correlation coefficient = 0.27). Observers from the same country reached a significantly higher level of agreement. The agreement on the necessity of correction was poor (intraclass correlation coefficient = 0.17). The most distinct features for diagnosing a septate uterus judged to be the extent of endocavitary bulging and the angle of the bulging structure from the fundal area.


The agreement among international experts on the hysteroscopic diagnosis of the septate uterus was found to be poor. This may have implications for the accuracy of screening hysteroscopy for diagnosing uterine cavity abnormalities in infertile patients. Development of consented definitions for the hysteroscopic diagnosis of septate and arcuate uterus is recommended.

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