Question:medium
An infertility patient has an ultrasound suggestive of a uterine anomaly. What is the best investigation to confirm the diagnosis?
An infertility patient has an ultrasound suggestive of a uterine anomaly. What is the best investigation to confirm the diagnosis?
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Consider which investigation can both diagnose internal and external uterine anomalies and treat them at the same sitting.
Updated On: Jun 23, 2026
- TVS (Transvaginal sonography)
- Hysteroscopy + Laparoscopy
- HSG (Hysterosalpingography)
- Laparoscopy
Show Solution
The Correct Option is B
Solution and Explanation
Best investigation: Hysteroscopy + Laparoscopy
When USG suggests a uterine anomaly in an infertility patient, the gold standard confirmatory investigation is the combined hysteroscopy-laparoscopy.
Why this combination?
- Hysteroscopy directly visualises the internal uterine cavity and can identify septa, adhesions (Asherman's syndrome), polyps, and submucosal fibroids
- Laparoscopy simultaneously evaluates the external uterine contour, distinguishing septate uterus (normal fundal outline) from bicornuate uterus (indented fundal contour) -- a distinction TVS and HSG cannot reliably make
- The combination also evaluates tubal patency, ovarian morphology, and peritoneal factors causing infertility
- Most importantly, it is diagnostic AND therapeutic: uterine septum resection can be performed at the same sitting
Limitations of other options:
- TVS: good screening, poor at characterising anomaly type
- HSG: shows internal cavity and tubal patency but not external uterine contour or peritoneal pathology
- Laparoscopy alone: cannot visualise internal cavity
\[\boxed{\text{Hysteroscopy + Laparoscopy}}\]
When USG suggests a uterine anomaly in an infertility patient, the gold standard confirmatory investigation is the combined hysteroscopy-laparoscopy.
Why this combination?
- Hysteroscopy directly visualises the internal uterine cavity and can identify septa, adhesions (Asherman's syndrome), polyps, and submucosal fibroids
- Laparoscopy simultaneously evaluates the external uterine contour, distinguishing septate uterus (normal fundal outline) from bicornuate uterus (indented fundal contour) -- a distinction TVS and HSG cannot reliably make
- The combination also evaluates tubal patency, ovarian morphology, and peritoneal factors causing infertility
- Most importantly, it is diagnostic AND therapeutic: uterine septum resection can be performed at the same sitting
Limitations of other options:
- TVS: good screening, poor at characterising anomaly type
- HSG: shows internal cavity and tubal patency but not external uterine contour or peritoneal pathology
- Laparoscopy alone: cannot visualise internal cavity
\[\boxed{\text{Hysteroscopy + Laparoscopy}}\]
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