Three-Dimensional Sonohysterography Compared With Vaginoscopic Hysteroscopy for Evaluation of the Uterine Cavity in Patients With Recurrent Implantation Failure in In Vitro Fertilization Cycles

Study ObjectiveTo 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.DesignComparative observational cross-sectional study (Canadian Task Force classification II-1).SettingPrivate assisted-conception unit.PatientsOne hundred forty-three patients with a history of at least 2 previous implantation failures despite transfer of good quality embryos in assisted-conception cycles.Interventions3D-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.Measurements and Main ResultsThere 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).ConclusionOur 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.