Ovarian Stimulation with FSH Alone versus FSH plus a GnRH Antagonist for Elective Freezing in an Oocyte Donor/Recipient Programme: A Protocol for a Pilot Multicenter Observational Study.

Preliminary data have shown that it is possible to attempt in vitro fertilization (IVF) treatment in fresh cycles without the use of a gonadotropin-releasing hormone (GnRH) antagonist or any other medication to prevent the luteinizing hormone (LH) surge during ovarian stimulation. To date, there is no information on this topic in the context of a prospective controlled trial. However, as prevention of the LH surge is an established procedure in fresh cycles, the question is whether such a study can be performed in frozen cycles. We aim to perform a pilot study in order to compare the efficacy of a protocol using FSH alone with that of a protocol using follicle-stimulating hormone (FSH) plus a GnRH antagonist for controlled ovarian hyperstimulation (COH) in cycles of elective freezing in the context of a donor/recipient program. This is a seven-center, two-arm prospective pilot cohort study conducted at the respective Assisted Reproductive Units in Greece. The hypothesis to be tested is that an ovarian stimulation protocol that includes FSH alone without any LH surge prevention regimens is not inferior to a protocol including FSH plus a GnRH antagonist in terms of the clinical outcome in a donor/recipient model. The results of the present study are expected to show whether the addition of the GnRH antagonist is necessary in terms of the frequency of LH secretory peaks and progesterone elevations >1 ng/mL during the administration of the GnRH antagonist according to the adopted frequency of blood sampling in all Units.

Follitropin Alpha for assisted reproduction: an analysis based on a non-interventional study in Greece.

OBJECTIVE: To conduct an economic evaluation estimating the cost per live birth after controlled ovarian stimulation (COS) using Follitropin Alpha (Gonal-F), in the Greek National Health System setting. A secondary objective was to predict the live birth rateof the In Vitro Fertilization (IVF) procedure. METHODS: A single arm, multi-center, prospective, non-interventional study was conducted on which economic, efficacy and safety data were collected by six of the largest IVF centers. The participants were 350 female patients. Three statistical methods were employed for the analysis of the study outcomes, namely (a) Generalized Linear Modeling for the estimation of the costs of IVF treatment, (b) multivariable logistic regression and (c) an Artificial Neural Network (ANN) model for live birth prediction. RESULTS: The mean total cost of IVF therapy per patient was estimated at €3728 (95% CI: €3679-€3780), while the total cost per live birth was €14,872 (95% CI: €12,441-€17,951). The live birth rate after 3 complete IVF cycles was estimated at 22.9%, while the percentage of those suffering from OHSS was limited at 0.57%. In logistic regression, the Ovarian Sensitivity Index (OSI) was a factor found to be positively associated with live birth (OR 7.39, 95% CI: 1.84-29.71). For the ANN, important predictors included number of gestational sacs and the duration of infertility. CONCLUSION: The present study constitutes the largest single-arm study based on real data in Greece to date. The cost of IVF treatment and the cost per live birth are not insignificant in this NHS setting. The live birth rate, cost per oocyte, and the cost per live birth are in line with literature. OSI was a main contributing factor to the accurate prediction of the live birth rate, while age and BMI were found to be negatively correlated.

Fertilization signatures as biomarkers of embryo quality.

Fertilization underpins the vital transition from gametic meiosis to embryonic mitosis. For decades, in human IVF, microscopic observation at a single time point has limited our appreciation of the morphokinetic complexity of this process. More recently, the introduction of time lapse technology-also enhanced by combination with artificial intelligence-has revealed the finest morphokinetic details of the beginning of human development. Overall, a picture has finally emerged in which the precise timing, morphology and geometry of several fertilization events offer clues to predict the fate of the embryo-a key aspect of assisted reproduction. In this scenario, correct unfolding of intra- and interpronuclear rearrangements emerge as a crucial factor to create a platform able to preserve genetic and cellular integrity at the first mitotic cleavage.

Premature ovarian insufficiency: A toolkit for the primary care physician.

Premature ovarian insufficiency (POI) refers to the loss of ovarian activity before the age of 40 years, which leads to hypoestrogenism and amenorrhoea. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for both the patient and her family. Therefore, it is very important that the diagnosis is correct and that it is made in a timely manner. Unfortunately, the diagnosis and therefore the effective treatment of POI are often delayed, which underlines the need for education of the broad medical community on the issue. A panel of menopause experts reviewed and critically appraised the literature, and present: 1) the diagnostic approach to POI, 2) the investigation of the etiology of this condition, 3) the therapeutic strategy regarding both hormone replacement therapy (HRT) and fertility and 4) the long-term follow-up and management for ensuring quality of life, as well as urogenital, cardiovascular, bone and mental health. The ultimate goal is to provide a complete toolkit for the primary care physician to have easy access to all the information needed for the optimal management of women with POI, in the context of evidence-based and personalized medicine.

The expression of Galectin-3 in breast cancer and its association with metastatic disease: a systematic review of the literature.

Breast cancer is the most common form of cancer and the second highest cause of cancer mortality in female patients. The significance of the expression of Galectin-3 has been correlated with various malignancy types and in data from several research papers, the expression of Galectin-3 has been associated with the progression and metastasis of breast cancer. In the present study, the authors' goal is to identify whether the expression of Galectin-3 in breast cancer can be associated with the presence and/or recurrence of a metastatic disease. Both Scopus and PubMed databases were utilized, by inputting the following combination of keywords: (((Breast) AND Metastasis)) AND ((Galectin 3) OR Galectin-3). The time of publication and text availability were not considered when searching the databases and all relevant articles in English were initially accepted. We included one case-control study, three retrospective case studies and one retrospective cohort study. In two of the included studies, the levels in concentration of Galectin-3 were not correlated with a significant difference in prognosis. In two studies, the lacking in expression of Galectin-3 was associated with a worse prognosis and in one of the studies selected, the elevated levels of Galectin-3 were correlated with recurrence of disease in triple negative breast cancer cases. For most of the studies selected for this review, the results were contradictory in regard to the role of Galectin-3 for prognosis and metastatic potential in female breast cancer patients. It is still unclear, whether Galectin-3 can be used as a prognostic marker for advanced breast cancer disease.

Investigating apoptotic, inflammatory, and growth markers in poor responders undergoing natural in vitro fertilization cycles: a pilot study.

This study investigates follicular fluid (FF) from patients with poor and normal ovarian response undergoing natural assisted reproductive technology cycles. We report about (1) cell-free DNA (cfDNA), which reflects apoptosis; (2) corticotropin-releasing hormone (CRH); (3) interleukin (IL)-15, which reflects inflammation; (4) granulocyte colony-stimulating factor (G-CSF); (5) vascular endothelial growth factor (VEGF); and (6) insulin-like growth factor I (IGF-I), which reflects follicular growth. Forty-four poor responders and 44 normal responders-according to the Bologna criteria-were recruited. FF samples were prepared for cfDNA quantification employing Q-PCR and for CRH, IL-15, G-CSF, VEGF, and IGF-I quantification employing ELISA. Statistically nonsignificant different levels of FF cfDNA, CRH, IL-15, VEGF, and IGF-I were observed. Interestingly, statistically significant higher G-CSF levels were observed in normal responders (302.48 ± 474.36 versus 200.10 ± 426.79 pg/mL, P = 0.003). Lower cfDNA integrity was observed in cycles resulting in clinical pregnancy for both groups (normal: 0.07 ± 0.04 versus 0.25 ± 0.17 ng/µL, P < 0.001; poor: 0.10 ± 0.06 versus 0.26 ± 0.12 ng/µL, P < 0.001). The results predominantly showcase similarities between normal and poor responders pertaining to inflammatory, apoptotic, and growth factors. This may be attributed to the employment of natural cycles in order to exclude controlled ovarian stimulation as a factor-indicating its detrimental effect. As G-CSF levels presented significantly higher in normal responders, its vital role in understanding a compromised ovarian response is highlighted.

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment.

Despite recent striking advances in assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. Poor responders constitute a heterogeneous cohort with the common denominator of under-responding to controlled ovarian stimulation. Inevitably, respective success rates are significantly compromised. As POR pathophysiology entails the elusive factor of compromised ovarian function, both diagnosis and management fuel an ongoing heated debate depicted in the literature. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. What is more, novel treatment approaches from stem cell therapy and platelet-rich plasma intra-ovarian infusion to mitochondrial replacement therapy have emerged, albeit not claiming clinical routine status yet. The complex and time sensitive nature of this subgroup of infertile patients indicates the demand for a consensus on a horizontally accepted definition, diagnosis and subsequent effective treating strategy. This critical review analyzes the standing criteria employed in order to diagnose and aptly categorize POR patients, while it proceeds to critically evaluate current and novel strategies regarding their management. Discrepancies in diagnosis and respective implications are discussed, while the existing diversity in management options highlights the need for individualized management.

Physical activity is associated with lower arterial stiffness in normal-weight postmenopausal women.

The impact of physical exercise, as preventative measure, to control the progression of cardiovascular disease in midlife remains under investigation. We aimed to investigate the effect of different levels of intensity of physical activity on metabolic and vascular profile in healthy postmenopausal women. A total of 625 healthy postmenopausal women (mean age 57.7 ± 7.6 years) were evaluated using the short IPAQ questionnaire for quantification of physical activity. The energy expenditure was estimated in metabolic equivalent of energy (MET) hours per week. Pulse wave velocity (PWV) was measured as an index of arterial stiffness. Intima-media thickness of both right and left common carotid artery, carotid bulb and internal carotid artery, and combined carotid IMT were also assessed by non-invasive and well-validated methods. Mean values of PWV decreased linearly with increasing intensity of physical activity (classes of physical activity: sedentary vs walking vs moderate vs vigorous activity: 9.07 ± 1.22 m/s vs 9.12 ± 1.72 m/s vs 8.47 ± 1.31m/s vs 7.94 ± 0.40 m/s, ANOVA P for linear trend .003). In non-obese postmenopausal women, PWV values associated with: (a) the total number of METs (b-coefficient = -0.261, P = .002) as well as with SBP; (b) or with the number of moderate METs (b-coefficient = -0.192, P = .025) as well as with age and SBP. No significant associations were observed between the intensity of physical exercise and arterial stiffness in the overweight-obese group. Physical activity is negatively associated with arterial stiffness in postmenopausal women with normal weight. This association was not observed in overweight or obese women.

Report of 7 uterine rupture cases after laparoscopic myomectomy: update of the literature.

The objective of this article is to report 7 previously unpublished uterine rupture cases in pregnancy after laparoscopic myomectomy and to update the medical literature. All cases were reported to the Board of Endoscopic Gynecologic Surgery (Athens, Greece) from 1998 to 2011. Myomas were single in 85.7% of patients, subserosal or pedunculated in 85.7%, and ≤5 cm in 71.4%. Bipolar diathermy was the sole method used for hemostasis in 28.6%, and could be characterized as excessive in 85.7%. A 2-layer closure with stitches of the myometrium was performed in just 14.3% of cases. Mean (SD) time between surgery and pregnancy was 1.4 (0.5) years. Uterine rupture occurred at 34 weeks of gestation or later in 85.7%, and during labor in 14.3% of cases. All women survived. Fetal demise was reported in 1 twin pregnancy (both fetuses) with rupture at 24 weeks of gestation. Laparoscopic myomectomy should be performed by adequately trained and experienced surgeons. Excessive use of diathermy for hemostasis should be avoided, and multiple-layer suturing should always be used for repairing the myometrial defect in cases of intramural and subserosal myomas with deep intrusion.

Response to hormonal treatment of young females with primary or very premature ovarian failure.

The aim of this study was to evaluate the impact of hormone treatment (HT) on several endocrinologic, metabolic and bone parameters in young women with primary or very premature ovarian failure. The study included 40 phenotypically females of 14-20 years old with primary or secondary amenorrhoea and female external genitalia. Study subjects were categorised in three groups: Group A included 12 subjects with Turner syndrome, Group B included 19 subjects with Swyer syndrome and Group C included 9 subjects with very premature ovarian failure. HT was administered for 24 months and included conjugated oestrogens and medroxyprogesterone acetate. In all groups, HT provided a beneficial hormonal profile and resulted in safe and adequate serum oestrogens levels. In Group A, no adverse effects on metabolic or coagulation parameters were noted; significant increases in high-density lipoprotein cholesterol (HDL) levels and bone density were observed. Similar positive effects of HT were observed in Group B. Finally, in Group C, no adverse effects of HT were noted, but the favourable increase in HDL was absent; bone density kept significantly increasing until the 12-month evaluation. In conclusion, the administration of HT is remarkably beneficial for young women with primary or very premature ovarian failure.

The expression of human leukocyte antigens class I and II in women with endometriosis or adenomyosis.

OBJECTIVES: The human leukocyte antigen (HLA) system has been implicated in the aetiology of endometriosis. We aimed to compare the HLA class I and II expression in endometrial specimens from women with endometriosis or adenomyosis. METHODS: We studied the HLA class I and II expression in endometrial specimens from 16 women with endometriosis and 15 with adenomyosis which were compared with 15 specimens from women without endometriosis or adenomyosis. Immunohistochemistry was performed using mouse antihuman IgG2a monoclonal antibody for HLA I and IgG1 for HLA II. RESULTS: Women with endometriosis had significantly higher HLA I and II expression in stroma (100% and 87.5% vs. 66.7% and 40%, p < 0.02 and p = 0.007, respectively) and glands (87.5% and 56.3% vs. 46.7% and 20%, p < 0.02 and p = 0.04, respectively) compared to controls, while in the adenomyosis group the expression of HLA I was comparable with controls and the HLA II expression was increased in stromal cells (73.3% vs. 40%, p = 0.03) and decreased in glands (6.6% vs. 20%, p = NS). CONCLUSION: Women with endometriosis had a significantly higher expression of HLA molecules whereas in adenomyosis there was a tendency of lower expression of these molecules. This could explain the suppression of cellular immunity in the peritoneal cavity.

The outcomes of hysteroscopy in women with implantation failures after in-vitro fertilization: findings and effect on subsequent pregnancy rates.

PURPOSE OF REVIEW: To update information on the findings of hysteroscopy in women with implantation failures after in-vitro fertilization (IVF) as well as on the effect of the procedure on subsequent pregnancy rates. RECENT FINDINGS: Information from three review publications indicates that the incidence of abnormal hysteroscopic findings in women with repeated implantation failures (RIFs) varies between 25 and 50%, whereas by pooling data from randomized studies, hysteroscopy significantly increases the clinical pregnancy rate (CPR) on the subsequent IVF cycle (pooled RR = 1.57, 95% CI: 1.29-1.92, P < 0.00001). Two recent clinical articles reported that the incidence of abnormal hysteroscopic findings in RIF patients was approximately 37%: the one study reported no differences in CPR between RIF patients with abnormal versus normal hysteroscopy; the second study reported significantly increased CPR in RIF patients with abnormal or treated hysteroscopic findings compared to those with a normal hysteroscopy, as well as in RIF patients having a hysteroscopy compared to controls not having the procedure. SUMMARY: There is accumulated evidence that hysteroscopy is beneficial for women experiencing implantation failures after IVF. Not only the correction of hysteroscopic findings improves the pregnancy rates, at least when compared to controls not having a hysteroscopy, but also the procedure itself may have a positive prognostic value for achieving a subsequent pregnancy.

Matrix metalloproteinases 2 and 9 and their tissue inhibitors in the follicular fluid of patients with polycystic ovaries undergoing in vitro fertilisation.

The present study was undertaken to investigate the levels of matrix metalloproteinase (MMP)-2, MMP-9 and their tissue inhibitors (TIMP-2 and TIMP-1, respectively) in the follicular fluid of 39 patients with polycystic ovary syndrome (PCOS) and compare them with the levels found in 56 age- and weight-matched normally ovulating women, all undergoing in vitro fertilisation (IVF) treatment. Significantly higher levels of MMP-2 and MMP-9 (p=0.02 and p<0.001, respectively) as well as TIMP-2 and TIMP-1 (p=0.006 and p<0.001, respectively) were found in the PCOS group compared to controls. Women who achieved pregnancy had higher TIMP-1 levels compared to the non-pregnant ones in the control group (p=0.01). In conclusion, women with PCOS exhibited significantly increased gelatinolytic activity compared with controls of similar age and body mass index, thus indicating a more intense extracellular matrix remodelling in this group of patients during IVF treatment due to multiple follicular development and cyst formation.

Treatment of sperm with platelet-activating factor does not improve intrauterine insemination outcome in unselected cases of mild male factor infertility: a prospective double-blind randomized crossover study.

OBJECTIVES: To evaluate the effect of sperm treatment with exogenous platelet-activating factor (PAF) on intrauterine insemination (IUI) clinical pregnancy rate in cases of mild male factor infertility. PAF is a phospholipid mediator, which is present in human sperm. METHODS: The study was performed in the Assisted Reproduction Unit of the 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece, and included 92 couples who presented with mild male factor infertility-all candidates for IUI. A maximum of 4 IUI cycles per couple with or without exogenous PAF treatment were performed and the main outcome measure was the clinical pregnancy rate (pregnancies confirmed by ultrasonography per 100 cycles). RESULTS: The overall clinical pregnancy rate after a maximum of 4 IUI cycles was comparable in cases with and without sperm treatment with PAF (12.24% vs 11.11%). Addition or exclusion of PAF sperm treatment in the same patients did not significantly alter the outcome. CONCLUSIONS: The generalized use of exogenous PAF for the preparation of sperm in unselected cases of mild male infertility does not improve the clinical outcome of IUI.

A unique case of trichorionic quadruplet pregnancy after oocyte donation in a patient with Turner's syndrome.

A 26-year old patient with a mosaic (45X/46XX) Turner's syndrome and secondary amenorrhea since the age of 19, was referred to the IVF unit for participation in oocyte donation program. After a complete work up including meticulous cardiological assessment, she had endometrial preparation with a high dose hormonal regimen, and transfer of three embryos derived from donated oocytes. An ongoing trichorionic quadruplet pregnancy was confirmed on ultrasound. The couple was offered fetal reduction to twins at 12 gestational weeks after consultation stressing the risks of a quadruplet pregnancy in general and especially in a patient with Turner's syndrome. No pregnancy or maternal complications were encountered and the patient delivered two healthy babies by lower segment cesarean section after spontaneous rupture of membranes at 36 gestational weeks.

Intrafollicular levels of matrix metalloproteinases-2 and -9 in patients with polycystic ovaries are not associated with pregnancy rate during IVF cycle.

This study aimed to detect the levels of matrix metalloproteinases (MMP)-2 and -9, using enzyme-linked immunosorbent assays, in the follicular fluid of 35 patients with polycystic ovaries, compare them with the levels found in 35 normally ovulating women enrolled in their first in vitro fertilization (IVF) cycle and then correlate them with pregnancy rates in these two groups. Levels of MMP-9 were found significantly increased in women with polycystic ovaries when compared with the controls, while MMP-2 levels were higher in women with polycystic ovaries without reaching statistical significance. The two groups did not differ in age, in the number of embryos transferred or in pregnancy rates. In conclusion, the results indicated an increased gelatinolytic activity in patients with polycystic ovaries after ovarian stimulation for IVF treatment without detecting any association between levels of MMP-2 and 9 and IVF pregnancy rates.

Hysteroscopy in women with implantation failures after in vitro fertilization: findings and effect on subsequent pregnancy rates.

OBJECTIVE: To evaluate hysteroscopic findings and estimate the effect of hysteroscopy on achieving a pregnancy in women with a history of 2 implantation failures after in vitro fertilization (IVF). DESIGN: Prospective observational and matched case control study. DESIGN CLASSIFICATION: II-2. SETTING: Private assisted reproduction units. PATIENTS: A total of 1475 patients with a history of 2 consecutive implantation failures after IVF who had a hysteroscopy were studied; there were 414 matched pairs of women with a similar history who either had or did not have a hysteroscopy. INTERVENTIONS: Hysteroscopy (diagnostic or operative), IVF/intracytoplasmic sperm injection cycle. MEASUREMENTS AND MAIN RESULTS: Hysteroscopic findings, clinical pregnancy rate (CPR), and ongoing pregnancy rate (OPR) were measured. In all, 36.6% of the study population had abnormal hysteroscopic findings and 22.2% had unsuspected findings; women with abnormal hysteroscopic findings showed significantly increased CPR and increased OPR in a new IVF cycle compared with those with a normal hysteroscopy result. Women who had a hysteroscopy showed significantly increased CPR and OPR compared with matched control subjects who did not have the procedure. Hysteroscopy and appropriate therapy significantly increased the chances of achieving a subsequent clinical and ongoing pregnancy. CONCLUSION: Women with 2 implantation failures after IVF had a remarkably high possibility for unsuspected abnormalities seen at hysteroscopy. Hysteroscopy could serve as a positive prognostic factor for achieving a subsequent pregnancy.

Low-molecular-weight heparin versus intravenous immunoglobulin for recurrent abortion associated with antiphospholipid antibody syndrome.

OBJECTIVE: To compare low-molecular-weight (LMW) heparin plus low-dose aspirin with intravenous immunoglobulin (IVIG) in the treatment of antiphospholipid antibody syndrome in women with recurrent spontaneous abortions before 10 weeks of gestation. METHOD: This prospective, multicenter trial conducted between 2002 and 2006 included 85 patients aged 18-39 years. The women were allocated randomly to receive LMW heparin plus low-dose aspirin, or IVIG. Data were compared using the t test and Fisher exact test. RESULTS: The women treated with LMW heparin plus low-dose aspirin had a higher rate of live births than those treated with IVIG (P=0.003). Of those who completed the study, 29/40 (72.5%) and 15/38 (39.5%), respectively, had live births. Intent-to-treat analysis revealed a significant difference between the 2 groups (OR 1.802; 95%CI, 1.14-2.84; P=0.007). CONCLUSIONS: LMW heparin plus low-dose aspirin resulted in a higher live birth rate than IVIG in the treatment of antiphospholipid antibody syndrome in women with recurrent abortion.

Day 4 versus day 3 embryo transfer: a prospective study of clinical outcomes.

OBJECTIVE: To compare the clinical outcomes after day 4 or day 3 embryo transfers in controlled ovarian hyperstimulation-IVF/intracytoplasmic sperm injection (ICSI) cycles. DESIGN: Prospective randomized study. SETTING: Center for Human Reproduction, 'Genesis Athens' Clinic (private gynecological and surgical clinic), Athens, Greece. PATIENT(S): Three hundred fifty women with primary infertility and indication for IVF/ICSI treatment. Patients were randomly allocated to day 4 or day 3 embryo transfer. INTERVENTION(S): Controlled ovarian hyperstimulation, oocyte retrieval, IVF/ICSI, embryo transfer. MAIN OUTCOME MEASURE(S): Implantation rate; clinical, ongoing, and multiple pregnancy rates. RESULT(S): A trend toward higher clinical and ongoing pregnancy rates was noted after day 4 embryo transfers. Implantation and multiple pregnancy rates were comparable after day 4 or day 3 embryo transfers. CONCLUSION(S): The transfer of day 4 embryos in IVF/ICSI cycles may result in favorable implantation and pregnancy rates which are at least comparable to those after the transfer of day 3 embryos.

Sonohysterography is superior to transvaginal sonography for the diagnostic approach of irregular uterine bleeding in women of reproductive age.

PURPOSE: To evaluate and compare the accuracy of transvaginal sonography (TVS) and sonohysterography (SHG) in the investigation of women of reproductive age presenting with irregular uterine bleeding (IUB). METHODS: This prospective study included 104 women presenting with IUB. All patients underwent TVS, SHG, and hysteroscopy, during which endometrial biopsies were obtained and any endometrial mass was treated with hysteroscopic surgery. Statistical analysis was performed by calculating the sensitivity, specificity, and positive and negative predictive values of TVS and SHG in diagnosing endometrial polyp, submucous myoma and all endometrial pathologies (polyp, submucous myoma, endometrial hyperplasia, and endometrial carcinoma) with the histopathological report of the tissues obtained by hysteroscopy serving as the end point for the analysis. RESULTS: The sensitivity, specificity, and positive and negative predictive values, respectively of TVS were 61.2%, 90.9%, 85.7%, and 72.5% for diagnosing endometrial polyps; 75.0%, 92.0%, 63.1%, and 95.3% for diagnosing submucous myomas; and 75.0%, 80.6%, 87.9%, and 63.0% for diagnosing any kind of pathology. The corresponding diagnostic values of SHG were 83.7%, 96.4%, 95.3%, and 86.9% for polyps; 87.5%, 98.9%, 93.3%, and 97.8% for submucous myomas; and 88.2%, 91.7%, 95.2%, and 80.5% for any kind of pathology. CONCLUSIONS: SHG showed superior sensitivity, specificity, and positive and negative predictive values compared with TVS in diagnosing intrauterine lesions in women of reproductive age with IUB.