Accuracy of Two-Dimensional Transvaginal Sonography and Office Hysteroscopy for Detection of Uterine Abnormalities in Patients with Repeated Implantation Failures or Recurrent Pregnancy Loss

Objective: to compare diagnostic values of two dimensional trans-vaginal sonography (TVS) and office hysteroscopy (OH) for evaluation of endometrial pathologies in cases with repeated implantation failure (RIF) or recurrent pregnancy loss (RPL). Methods and Materials: This prospective study was performed in Royan institute from December 2013 to January 2015. TVS was performed before hysteroscopy as part of the routine diagnostic work-up in 789 patients who had RIF or RPL problem. Uterine biopsy was performed in cases with abnormal diagnosis in TVS and/ or hysteroscopy. Diagnostic accuracy values of TVS in detection of uterine abnormalities were compared with office hysteroscopy by using ROC (Receiver Operating Characteristics) curve analysis. Results: In the TVS examination, 545 (69%) of cases were detected as normal and 244 (31%) of cases as pathologic, which included 84 endometrial polyps (10.6%), 15 uterine fibroids (1.6%), 10 Asherman’s syndrome (1.3%), 9 endometrial hypertrophy (1.1%), 126 septate uterus and arcuate uterus (15.9%). TVS and office hysteroscopy were in agreement in 163 pathologic cases; although TVS was not able to detect some cases with pathology (n=120). The analysis revealed that office hysteroscopy had sensitivity, specificity, PPV and NPV for detection of endometrial polyps are 94%, 95%, 62%, 99% respectively and in the diagnosis of myoma all the corresponding values were 100%. The findings demonstrated that the sensitivity and specificity of TVS for the diagnosis of myoma and polyps were 50%, 98% and 54%, 80% respectively. Area under ROC curve (AUROC) was almost good 70.69% for the accuracy of TVS in comparison with OH. Conclusion: The present study noted that TVS had high specificity and low sensitivity for detection of uterine pathologies in patients with RIF or RPL diagnosis compared with OH. It seems that the OH should be considered as workup method prior to treatment cycle in these patients with normal TVS.