Hysteroscopic evaluation of uterine cavity in cases of infertility and its correlation with transvaginal ultrasound and hysterosalpingography

Abstract

Background: Infertility is defined as one year of unprotected intercourse without pregnancy. This study was taken up to evaluate the diagnostic accuracy of hysteroscopy in comparison with hysterosalpingography and vaginal ultrasound in the evaluation of the uterine cavity as first line study in the infertile patient. Methods: A Prospective and comparative study was carried out in the department of Obstetrics and Gynaecology, S.S. Medical College and associated Gandhi Memorial Hospital, Rewa, MP, India in a period of 13 months from August 2014 to September 2015 conducted on 60 subjects. Results: 60 patients were evaluated with diagnosis of primary and secondary infertility. Hysteroscopy showed alterations in 65%, predominantly uterine synechiae, chronic endometritis and endometrial polyp. Hysterosalpingography reported a sensitivity of 90% and a specificity of 100%, with a positive predictive value of 100% and a negative predictive value of 66.6%. The agreement between the two methods was moderate. The transvaginal ultrasound reported a sensitivity of 51.21% and a specificity of 100%, the agreement between these two procedures was moderate. There were no complications during hysteroscopy. Conclusions: We believe that transvaginal ultrasound, hysterosalpingography and hysteroscopy are complementary in the evaluation of the infertile patient but Hysteroscopy can diagnose small intrauterine lesions much more precisely, (compared with HSG and even TVS) and treat them simultaneously. Thus we consider routine hysteroscopy should be included in the evaluation of the infertile couple.