Original Research Article Indian Journal of Obstetrics and Gynecology Research 2016;3(3):270-273 270 Uterine cavity assessment prior to in vitro fertilization: comparison of 3D transvaginal ultrasonography accuracy versus office hysteroscopy Vineet V. Mishra 1,* , Preeti A. Goyal 2 , Raveendra P. Gondhali 3 , Rohina S. Aggrawal 4 , Sumesh D. Choudhary 5 , Sakshi S. Nanda 6 , Tanvir 7 1 Professor & HOD, 2 Senior Resident, 3,5 Assistant Professor, 4 Professor, 6 Clinical Fellow, 7 Senior Resident, Institute of Kidney Diseases & Research Centre & Institute of Transplantation Sciences *Corresponding Author: Email: vineet.mishra.ikdrc@gmail.com Abstract Objective: To compare accuracy of 3-D transvaginal sonography (TVS) versus office hysteroscopy (OH) in the evaluation of uterine cavity abnormalities in infertile women undergoing IVF procedures. OH considered as gold standard. Study Design: A prospective observational study. Settings: A tertiary care centre. Materials and Methods: This is a prospective observational study conducted in 667 infertile women who were scheduled for IVF treatment at our department during June 2014 to December 2015. Main outcome measures- The prevalence of abnormal uterine cavity was 11.52% as detected by office hysteroscopy. There was failed hysteroscopy in 7 women due to cervical stenosis. 3D TVS and OH findings were normal in 631 (95.61%) and 584 (88.48%) women and abnormal in 29 (4.39%) and 76(11.52%) women respectively. This difference is statistically significant with p-value < 0.01. False positive and false negative results for 3 D TVS are 16(2.74%) and 63(82.89%). Considering OH as gold standard, 3 D TVS has 17.11% sensitivity, 97.26% specificity, 44.83% positive predictive value and 90.02% negative predictive value. Conclusion: Uterine cavity abnormalities are considered to have a negative impact on the embryo implantation rates in IVF. OH should be considered as the primary modality to assess uterine cavity in IVF as it can be done without anesthesia and gives accurate diagnosis. Though 3 D TVS is easier, cost effective, non-invasive and have no complications as compared to OH but due to its low sensitivity (17.11%), low PPV (44.83%) and high false negative (82.89%) results, it has a limited role in IVF. Keywords: 3 D TVS, OH, IVF, Uterine cavity, Implantation rates, Pregnancy Access this article online Quick Response Code: Website: www.innovativepublication.com DOI: 10.5958/2394-2754.2016.00060.6 Introduction A successful pregnancy outcome for patients undergoing IVF depends on several factors. Among these factors embryo quality, favorable intrauterine environment and a skillful IVF laboratory are prerequisites to achieve a successful pregnancy outcome. Intrauterine abnormalities play an important role in implantation failure in IVF procedures. Abnormal uterine findings have been reported in nearly 34% to 62% of infertile women. (1,2,3) A variety of modalities such as hysterosalpingography (HSG), transvaginal sonography (TVS), diagnostic hysteroscopy, three dimensional transvaginal sonography (3-D TVS) and three dimensional saline sono hysterography (3-D SIS) can be used for the diagnosis of uterine abnormalities. Hysteroscopy has remained the gold standard in infertility investigation (2,4,5) with high diagnostic accuracy and has become popular now days. The availability of hysteroscopes with smaller diameter has made the use of outpatient or office hysteroscopy feasible as a routine examination (6) . It permits direct visualization of the uterine cavity revealing the nature, location, shape, size and vascular pattern of various uterine cavity abnormalities such as polyps, submucosal fibroids, septa and adhesions. The advent of transvaginal 3D ultrasonography has enabled the accurate, noninvasive, outpatient diagnosis of congenital uterine anomalies and can be considered as an alternative to office hysteroscopy with fewer costs and no complications. (7, 8) 3D TVS offer examinations of adnexa and pelvis in addition to uterus. We carried out this study to compare accuracy of 3- D TVS versus office hysteroscopy in the evaluation of uterine cavity abnormalities in infertile women undergoing IVF procedures. Materials and Methods This is a prospective observational study conducted in 667 infertile women who were scheduled for IVF/ICSI treatment in our IVF unit at Institute Of Kidney Diseases and Research Centre and Institute Of Transplantation Sciences, Ahmedabad, India during a period from June 2014 to December 2015. Approval of the study protocol was taken from the ethical committee of the institute. An informed written consent was obtained from all women who were enrolled in this study.