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 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. Design: Comparative observational cross-sectional study (Canadian Task Force classification II-1). Setting: Private assisted-conception unit. Patients: 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. Interventions: 3D-SHG was followed by VH. The Cohen kappa 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 Results: There was a substantial degree of concordance between 3D-SHG and VH (kappa = 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). Conclusion: 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. Journal of Minimally Invasive Gynecology (2012) 19, 503-508 (C) 2012 AAGL. All rights reserved.