An overview of the results of hysterosonography prior to in vitro fertilization

Abstract

Objective: This study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy.

Methods: Findings from 197 hysterosonograms of patients examined in an assisted reproduction clinic between January 2012 and August 2014 were included. Enrollment criteria: patients in preparation for IVF not recently submitted to uterine examination through hysterosalpingography or hysteroscopy referred to hysterosonography. Uterine cavity evaluation was considered anomalous when one or more of the following were found: polyps, submucous myomas, uterine synechiae, Müllerian duct anomalies. Individuals with cavity abnormalities that might interfere with IVF results were referred to hysteroscopy.

Results: Normal test results were seen in 170/197 of the cases (86.3%). Eighteen of the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct anomalies. Sixteen of the patients diagnosed with abnormalities underwent hysteroscopy to confirm or treat the suspected pathology. In only two cases there was no agreement between tests: one patient suspected for synechiae and another for polyps were not confirmed; another individual suspected for polyps was found to have focal endometrial thickening in hysteroscopy. The positive predictive value (PPV) in our study was 93.7%.

Conclusion: In most cases, the diagnoses obtained by hysterosonography showed normal uterine cavities. The most common anomalous findings were polyps, followed by synechiae, submucous myoma, and Müllerian duct anomalies. Hysterosonography is a good option for evaluating the uterus and offers a high positive predictive value, while hysteroscopy stands as the gold standard.

Keywords: IVF; endometrial polyp; hysteroscopy; hysterosonography; submucous myomas; uterine synechiae.

Figure 1

The distention of the uterine cavity produced after the infusion of saline solution allows for better visualization of pathologies. An endometrial polyp measuring 5.8 mm can be seen on the back wall.