Traditionally, laparoscopy was considered to be the gold standard for the examination of endometriotic lesions, because it allows their direct visualization. Several international and national guidelines have now shifted their focus to non‐invasive imaging‐based diagnosis of deep endometriosis in preference to surgery, while laparoscopy is used to diagnose superficial endometriosis in patients with painful symptoms and negative ultrasound and/or magnetic resonance imaging findings for ovarian or deep endometriosis. In recent years, however, the role of gynecological ultrasound in the diagnosis of superficial endometriosis has been studied more extensively. The purpose of this addendum to the International Deep Endometriosis Analysis consensus opinion is to describe a standardized ultrasound protocol for the diagnosis of superficial endometriosis and to highlight the sonographic characteristics of these lesions. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Objectives: The objective of this study was to examine the prevalence of chronic endometritis (CE) in infertile women, its impact on reproductive outcomes, and the accuracy of hysteroscopy as a screening tool for CE. Design: This was a prospective observational study. Participants: Participants involved in this study were 514 asymptomatic patients with infertility. Setting: The review was conducted in a tertiary care center. Methods: The participants underwent a hysteroscopy and endometrial biopsy (EMB). Antibiotics were given for cases of CE. We investigated the prevalence of CE in patients starting assisted reproductive technologies (ART) as a primary outcome. Secondary outcomes were the clinical pregnancy rate (CPR) in the ART cycle after hysteroscopy, EMB, and antibiotic treatment in cases of CE; the cumulative CPR in the subsequent 2 years after hysteroscopy and EMB; the sensitivity and specificity of hysteroscopy as a screening tool compared to EMB as the “gold standard” for diagnosing CE. Results: CE was identified in 2.8% of patients starting ART (11/393). CPRs did not differ significantly between patients with CE and the entire cohort of patients without CE in the subsequent ART cycle (OR: 0.43; 95% CI: 0.09–2.02) or in the 2 years after EMB (OR: 0.56; 95% CI: 0.16–1.97). In a matched control comparison (with matching for age, basal FSH, and cause of infertility), CPR in patients with CE did not differ in the subsequent ART cycle (OR: 0.39; 95% CI: 0.09–1.61); however, their CPR in the 2 years after EMB was significantly lower (OR: 0.22; 95% CI: 0.13–0.38). The sensitivity and specificity of hysteroscopy as a screening tool for diagnosing CE were 8.3% and 90.1%, respectively. Limitations: Due to our cohort’s low CE prevalence, we could not detect significant differences in CPRs. Conclusion: CE is rare in our studied population of asymptomatic patients starting ART. Hysteroscopy cannot replace EMB for diagnosing CE.