ABSTRACT
Background: We sought to compare diagnostic values of two-dimensional transvaginal sonography [2D TVS] and office hysteroscopy [OH] for evaluation of endometrial pathologies in cases with repeated implantation failure [RIF] or recurrent pregnancy loss [RPL]
Materials and Methods: This prospective study was performed at Royan Institute from December 2013 to January 2015. TVS was performed before hysteroscopy as part of the routine diagnostic work-up in 789 patients with RIF or RPL. Uterine biopsy was performed in cases with abnormal diagnosis in TVS and/or hysteroscopy. We compared the diagnostic accuracy values of TVS in detection of uterine abnormalities with OH by receiver operating characteristic [ROC] curve analysis
Results: TVS examination detected 545 [69%] normal cases and 244 [31%] pathologic cases, which included 84 [10.6%] endometrial polyps, 15 [1.6%] uterine fibroids, 10 [1.3%] Asherman's syndrome, 9 [1.1%] endometrial hypertrophy, and 126 [15.9%] septate and arcuate uterus. TVS and OH concurred in 163 pathologic cases, although TVS did not detect some pathology cases [n=120]. OH had 94% sensitivity, 95% specificity, 62% positive predictive value [PPV], and 99% negative predictive value [NPV] for detection of endometrial polyps. In the diagnosis of myoma, sensitivity, specificity, PPV, and NPV were 100%. TVS had a sensitivity of 50% and specificity of 98% for the diagnosis of myoma. For polyps, TVS had a sensitivity of 54% and specificity of 80%. Area under the ROC curve [AUROC] was 70.69% for the accuracy of TVS compared to OH
Conclusion: TVS had high specificity and low sensitivity for detection of uterine pathologies in patients with RIF or RPL compared with OH. OH should be considered as a workup method prior to treatment in patients with normal TVS findings