Can Three-Dimensional Transvaginal Sonography Replace Office Hysteroscopy in Detecting Uterine Abnormalities in Infertility Patients?

Background: Evaluation of uterine cavity is an important step during investigation of infertile women. The presence of uterine pathology causes impaired receptivity, failed implantation and poor pregnancy outcomes. Various investigative modalities though available; have their limitations. Hysteroscopy considered the gold standard diagnostic modality is invasive; thus, an investigation which could overcome its limitations was required. 3-Dimensional transvaginal sonography (3D TVS), which non-invasively visualizes uterine morphology, registers all three imaging planes simultaneously could be an alternative to hysteroscopy.

Aim: To compare 3-D TVS with the gold standard office hysteroscopy for evaluating uterine cavity in sub fertile women.

Setting And Design: It was a comparative study carried out at the Reproductive Medicine Centre of a tertiary care hospital.

Materials And Methods: Over 12 months , 154 women with infertility underwent both hysteroscopy and 3D TVS. The primary outcome was to compare the sensitivity and specificity of 3D TVS in diagnosing endouterine abnormalities and assess if 3-DTVS could replace hysteroscopy for evaluation of uterine cavity.

Statistical Analysis: The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of the 3-D TVS was calculated.

Results: The 3-D TVS had a sensitivity of 88.46% ; specificity of 99.21% for detection of uterine abnormalities with hysteroscopy as gold standard. The Positive Predictive Value was 95.83%; Negative Predictive Value 97.69% and diagnostic accuracy was 97.4%. It was seen that of 24 lesions diagnosed by 3D TVS, hysteroscopy was in agreement with 21 lesions.

Conclusion: 3D TVS with advantages of giving better spatial orientation, non-invasive, pain free, can replace hysteroscopy for screening endouterine lesions. With no statistically significant superiority of hysteroscopy over 3D TVS as seen in this study it may be deemed unnecessary in 50% patients having normal uterine cavity.