Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure.

Abstract

Background and aim: Hysteroscopy is the gold standard for diagnosing endometrial and cervical canal pathology and can be used alone or in combination with other methods. The study aimed to compare abnormal findings of vaginal color Doppler ultrasonography (transvaginal sonography [TVS]) and hysteroscopy.

Methods: This study involved 100 infertile women with a history of two or more failed implantations of in vitro fertilization (IVF) from January 2020 to January 2021 in the infertility ward of Al-Zahra Hospital in Tabriz, Iran. All patients underwent hysteroscopy and TVS in the follicular phase to examine the endometrial cavity. We calculated the sensitivity and agreement of TVS color Doppler compared to hysteroscopy and using appropriate statistical tests.

Results: The overall proportion of abnormal findings was 69 and 66% through hysteroscopy and TVS. The sensitivity and kappa statistics of TVS compared to hysteroscopy were 95.6 and 93.2%, respectively. Endometrial polyps were the most common abnormalities in hysteroscopy (31%) and TVS (25%). In examining the relationship between hysteroscopy findings and vaginal color Doppler ultrasonography findings, a significant association was found between submucosal myoma and non-homogeneous myometrium (OR = 1.8 (1.02-5.3); P = 0.027), endometrial polyps and non-homogeneous myometrium (OR = 2.7 (1.04-7.4); P = 0.025), intrauterine adhesion and uterine artery PI (OR = 1.9 (1.3-8.2); P = 0.001), endometrial atrophy and endometrial thickness (OR = 2.4 (1.01-4.5); P = 0.034), and thick/irregular endometrium and adenomyosis (OR = 2.5 (1.4-15.9); P = 0.001).

Conclusion: Abnormal findings of hysteroscopy and TVS were observed more in patients who have a history of two or more unsuccessful IVFs. Comparing and evaluating the relationship between them can be considered a positive prognostic factor and a better diagnosis for achieving pregnancy in the IVF procedure in women with a history of recurrent implantation failure.