title: Can combination of hysterosalpingography and ultrasound replace hysteroscopy in diagnosis of uterine malformations in infertile women?
abstract: BACKGROUND
  Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard for evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about the accuracy of these tests. The aim of this study was to evaluate the accuracy of the combination of TVS and HSG with hysteroscopy as the gold standard.
  
  
  METHODS
  Medical records of infertile women who were undertaken all three diagnostic modalities were reviewed to analyze their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
  
  
  RESULTS
  Ninety-nine infertile women were assessed with a mean±SD age of 29.1±6.47 years, mean±SD duration of themarriage of 8.9±10.28 years, and mean±SD duration of infertility of 5.6± 4.16 years. The sensitivity, specificity, PPV, and NPV of TVS were 98.55%, 30%, 76.4%, and 90%, respectively. HSG had a sensitivity of 95.6%, specificity of 60%, PPV of 84.62%, and NPV of 85.71%.When both modalities were combined, the sensitivity, specificity, PPV, and NPV were 94.2, 66.67, 86.67, and 83.33%, respectively. The diagnostic accuracy of single TVS, HSG or combined techniques was statistically similar that was equal to 77.7, 84.8 and 85.8 % respectively.
  
  
  CONCLUSIONS
  The accuracy of combination of two diagnostic modalities, 2D TVS and HSG is not higher than HSG alone for assessing uterine malformation in infertile women.
authors.affiliation: MD, Assistant Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. mansoureh_vahdat@yahoo.com.
authors.forename: Mansoureh
authors.initials: M
authors.lastname: Vahdat
authors.affiliation: MD, Assistant Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. drelaheh_sariri@yahoo.com.
authors.forename: Elaheh
authors.initials: E
authors.lastname: Sariri
authors.affiliation: MD, Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran. maryamkashanian@yahoo.com.
authors.forename: Maryam
authors.initials: M
authors.lastname: Kashanian
authors.affiliation: MD, Assistant Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. zahranaj@yahoo.com.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Najmi
authors.affiliation: MD, General Practitioner, Department of Obstetrics and Gynecology, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. dr.mobasseri@yahoo.com.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mobasseri
authors.affiliation: MD, Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. drmahjabin@yahoo.com.
authors.forename: Mahjabin
authors.initials: M
authors.lastname: Marashi
authors.affiliation: MD, Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. dr.mohabatian@gmail.com.
authors.forename: Behnaz
authors.initials: B
authors.lastname: Mohabbatian
authors.affiliation: MD, Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. shideh.ryn@yahoo.com.
authors.forename: Shideh
authors.initials: S
authors.lastname: Ariana
authors.affiliation: MSc, Pars Advanced Minimally Invasive Manners Research Center, Iran University of Medical Sciences, Tehran, Iran. yousefmoradi211@yahoo.com.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Moradi
keywords: Accuracy; Hysterosalpingography; Hysteroscopy; Infertility; Müllerian anomaly; Ultrasound