Transvaginal sonography of the uterine cavity with hysteroscopic correlation in the investigation of infertility.

This report describes the correlation of hysteroscopic findings with preoperative transvaginal sonography in 200 patients being investigated for infertility. Real-time ultrasound examination was performed on days 7, 14 and 21 in spontaneous ovulatory cycles. Diagnostic hysteroscopy was performed in the subsequent cycle. The abnormalities detected using transvaginal sonography were intrauterine adhesions, submucous fibroids, endometrial polyps, endometritis and a non-specific irregular endometrium. A total of 182 patients were diagnosed correctly to have an abnormality by transvaginal sonography giving a false-positive rate of 5.5%. The sensitivity of transvaginal sonography in detecting endometrial pathology was 98.9% with a positive predictive value of 94.3%. The positive predictive values for specific abnormalities were 98.5% for intrauterine adhesions, 91.7% for submucous fibroids, 91.4% for endometrial polyps, 85.7% for endometritis and 85.7% for irregular endometrium. These data show a strong correlation between findings from transvaginal sonography and hysteroscopy. Transvaginal sonography may be used to detect intrauterine pathology and identify patients in whom hysteroscopy and hysteroscopic surgery are indicated.