Design: This video series represents patients undergoing hysteroscopy for infertility and recurrent pregnancy loss. Hysteroscopy was performed under general anesthesia to ensure adequate cavity distension and optimal visualization, as in-office hysteroscopy may be limited by patient discomfort.

Setting: University-associated reproductive medicine center.

Patients or Participants: Patients undergoing workup for infertility and recurrent pregnancy loss.

Interventions: Diagnostic/operative hysteroscopy

Measurements and Main Results: An ACMI 0° or 12° 7mm hysteroscope lens (Division of Olympus; Maple Grove, MN, USA) was used. Normal saline was used as initial distension media and switched to 1.5% glycine for operative portion. A straight resectoscope loop electrode and hysteroscopic scissors were used for septum measurement and incision. With the hysteroscopic uterine palpator as a reference, standardized measurements of the instruments were established to allow for indirect and direct measurements of the septum length. Indirect measurement was obtained by measuring from the level of the tubal ostia to the apex. Using Pythagorean's theorem, indirect measurement was multiplied by 60% to get an estimate of the septum length. Direct measurement was performed after septum incision by measuring from the apex to the base of the incised septum.

Conclusion: There is a wide variety of presentations of the partial septate uterus. ASRM defines a lower proportion of partial septate uteri as compared to ESHRE-ESGE & CUME, leaving a large proportion of patients with neither a diagnosis of an arcuate uterus nor a partial septate uterus. Adopting diagnostic criteria focused on fundal indentation depth rather than apex angle may be more inclusive.