title: Three-dimensional sonohysterography compared with vaginoscopic hysteroscopy for evaluation of the uterine cavity in patients with recurrent implantation failure in in vitro fertilization cycles.
abstract: OBJECTIVE
  To estimate the degree of agreement between 3-dimensional sonohysterography (3D-SHG) and vaginoscopic hysteroscopy (VH) in detection of uterine cavity abnormalities in patients with recurrent implantation failure in in vitro fertilization cycles.
  
  
  METHODS
  Comparative observational cross-sectional study (Canadian Task Force classification II-1).
  
  
  METHODS
  Private assisted-conception unit.
  
  
  METHODS
  One hundred forty-three patients with a history of at least 2 previous implantation failures despite transfer of good quality embryos in assisted-conception cycles.
  
  
  METHODS
  3D-SHG was followed by VH. The Cohen κ for interrater agreement was calculated for the level of agreement between the 2 diagnostic procedures. Procedure time in seconds was recorded for both procedures. Patients were asked to rate their degree of discomfort or pain during both procedures using a visual analog scale.
  
  
  RESULTS
  There was a substantial degree of concordance between 3D-SHG and VH (κ = 0.77; 95% confidence interval, 0.6-0.84). The median procedure time for 3D-SHG was 296 seconds (range, 231-327 seconds), and for VH was 315 seconds (range, 232-361 seconds), and the difference was statistically significant (p =.02). The visual analog scale pain scores also showed that 3D-SHG, with a median pain score of 2.1 (range, 1-3) was better tolerated than VH, with a median pain score of 2.9 (range, 2-4) (p < .001).
  
  
  CONCLUSIONS
  Our results show that there is a substantial degree of concordance between 3D-SHG and VH in diagnosing uterine cavity anomalies. We also found that 3D-SHG took significantly less time and induced less patient discomfort than did VH. We recommend that 3D-SHG should be the method of first choice for outpatient evaluation of the uterine cavity.
authors: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Hayat Fertility and Women's Health Center, Maadi, Cairo, Egypt. sherifnegm@hotmail.com
authors: Sherif M M
authors: SM
authors: Negm
authors: Rasha A
authors: RA
authors: Kamel
authors: Fouad A
authors: FA
authors: Abuhamila
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D010064:Embryo Implantation; D019160:Endosonography / Q000009:adverse effects; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007047:Hysterosalpingography / Q000009:adverse effects; D015907:Hysteroscopy / Q000009:adverse effects; D021621:Imaging, Three-Dimensional; D007246:Infertility / Q000209:etiology / Q000628:therapy; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D018709:Statistics, Nonparametric; D013997:Time Factors; D017211:Treatment Failure; D014591:Uterine Diseases / Q000150:complications / Q000175:diagnosis*; D014599:Uterus / Q000002:abnormalities* / Q000000981:diagnostic imaging*