Value of 3-Dimensional Sonohysterography in Infertility Work-up

Abstract

Study Objective To compare the diagnostic value of 2-dimensional (2D) and 3-dimensional (3D) sonohysterography (SHG) and outpatient hysteroscopy (OH) in detecting intrauterine lesions in infertile women. Design Comparative, observational, cross-sectional study (Canadian Task Force Classification II-2). Setting University hospital. Patients One hundred eighty women with a normal uterine cavity at transvaginal ultrasound and hysterosalpingography (HSG) underwent infertility workup at our outpatient clinic. Interventions All patients underwent 2D-SHG, 3D-SHG, and OH. Measurements and Main Results Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 2D-SHG and 3D-SHG were compared with OH in detecting intrauterine lesions. For 2D-SHG, sensitivity was 0.70 (95% confidence interval [CI], 0.49–0.85), specificity was 1.0 (95% CI, 0.96–1.0), PPV was 1.0 (95% CI, 0.79–1.0), NPV was 0.95 (95% CI, 0.9–0.97), and accuracy was 95.5%. For 3D-SHG, sensitivity was 0.92 (95% CI, 0.74–0.98), specificity was 1.0 (95% CI, 0.97–1.0), PPV was 1.0 (05% CI, 0.83–1.0), NPV was 0.98 (95% CI, 0.95–0.99), and accuracy was 98.8%. For OH, sensitivity was 1.0 (95% CI, 0.85–1.0), specificity was 1.0 (95% CI, 0.97–1.0), PPV was 1.0 (95% CI, 0.84–1.0), NPV was 1.0 (0.97–1.0), and accuracy was 100%. Thus, 3D-SHG is comparable to OH in diagnosing intrauterine lesions (p = .23), and both are superior to 2D-SHG (p <0.001). Conclusion The diagnostic value of 3D-SHG is comparable to OH in detecting intrauterine lesions, and both are superior to 2 D-SHG. 3D-SHG should be included in the infertility workup even in women with a normal uterine cavity at transvaginal ultrasound or hysterosalpingography.