Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility

Josef Shalev*, Israel Meizner, Itay Bar-Hava, Dov Dicker, Reuben Mashiach, Zion Ben-Rafael

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To compare transvaginal sonography with hysteroscopy for the evaluation of intrauterine disorders. Design: Clinical study. Setting: Academic research environment.Patient(s): Patients who were undergoing initial evaluation for primary or secondary infertility or investigation after three failed IVF attempts. Intervention(s): 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. Main Outcome Measure(s): Intrauterine adhesions, endometrial polyps.Result(s): 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.Conclusion(s): 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. Copyright (C) 2000 American Society for Reproductive Medicine.

Original languageEnglish
Pages (from-to)412-417
Number of pages6
JournalFertility and Sterility
Issue number2
StatePublished - Feb 2000


  • Endometrium
  • Hysteroscopy
  • Infertility
  • Transvaginal sonography
  • Uterine synechiae


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