title: Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility.
abstract: OBJECTIVE
  To compare transvaginal sonography with hysteroscopy for the evaluation of intrauterine disorders.
  
  
  METHODS
  Clinical study.
  
  
  METHODS
  Academic research environment.
  
  
  METHODS
  Patients who were undergoing initial evaluation for primary or secondary infertility or investigation after three failed IVF attempts.
  
  
  METHODS
  Transvaginal sonography was performed, followed by hysteroscopy, between January 1998 and April 1999. The endometrial findings at sonography were compared with those at hysteroscopy, which served as the gold standard. The characteristic sonographic features of intrauterine adhesions were defined.
  
  
  METHODS
  Intrauterine adhesions, endometrial polyps.
  
  
  RESULTS
  The sensitivity, specificity, and positive and negative predictive values for transvaginal sonography in detecting abnormal uterine cavities were 100%, 96.3%, 91.3%, and 100%, respectively. The corresponding values for the specific diagnoses of intrauterine adhesions and endometrial polyps were 80%, 100%, 100%, and 97%, and 71.4%, 100%, 100%, and 97.1%, respectively. On transvaginal sonography, intrauterine adhesions appeared as hyperechoic endometrial foci and were differentiated from endometrial polyps by their irregular shape and more precise localization. The performance of transvaginal sonography at midcycle (three-layer endometrium) rather than after menstrual cessation (endometrial thickness <3 mm) enabled better imaging of small intrauterine adhesions.
  
  
  CONCLUSIONS
  A regular myometrial-endometrial interface and homogeneous endometrial structure on transvaginal sonography congruent with the phase of the menstrual cycle indicated a normal endometrium and precluded the need for diagnostic hysteroscopy. Transvaginal sonography may be used as the initial diagnostic procedure to select patients for hysteroscopy.
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center-Beilinson Campus, Petah Tikva, Israel. shalevyo@internet-zahav.net
authors.forename: J
authors.initials: J
authors.lastname: Shalev
authors.forename: I
authors.initials: I
authors.lastname: Meizner
authors.forename: I
authors.initials: I
authors.lastname: Bar-Hava
authors.forename: D
authors.initials: D
authors.lastname: Dicker
authors.forename: R
authors.initials: R
authors.lastname: Mashiach
authors.forename: Z
authors.initials: Z
authors.lastname: Ben-Rafael
mesh_terms: D000328:Adult; D004717:Endometrium / Q000000981:diagnostic imaging; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007247:Infertility, Female / Q000000981:diagnostic imaging*; D008597:Menstrual Cycle; D011237:Predictive Value of Tests; D011859:Radiography; D014463:Ultrasonography / Q000379:methods; D014591:Uterine Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D014599:Uterus / Q000000981:diagnostic imaging* / Q000473:pathology; D014621:Vagina / Q000000981:diagnostic imaging