Three-Dimensional Ultrasound versus Hysteroscopy in Uterine Cavity Assessment after Failed Intracytoplasmic Sperm Injection: a study for accuracy of a diagnostic test | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 28, Volume 72, Issue 5, July 2018, Page 4565-4571 PDF (274.29 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2018.9548 | ||||
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| Authors | ||||
Faten Mosbah Ibrahim Al-Zinaty  1; Tarek Aly Raafat2; Mohammed Sayed Ali2; Mohammed Mahmoud Al Sherbeeny2
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| 1Obstetrics and Gynecology Clinics, Al-Tayseer Clinics | ||||
| 2Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-Shams University | ||||
| Abstract | ||||
| Background: Implantation failure after intracytoplasmic sperm injection (ICSI) is related to either maternal factors or embryonic causes. The maternal factors include uterine anatomic abnormalities either congenital or acquired. Three-dimensional transvaginal ultrasound allows detailed evaluation of pelvic organs. Office hysteroscopy is the gold standard tool for visualization of intracavitary lesions and the cervical canal in an office-based environment. Aim of The Work: It was to compare between three-dimensional ultrasound (3D USS) and hysteroscopy for evaluation of the intrauterine cavity after trial of ICSI and to study the accuracy of diagnostic test in a tertiary care facility. Patients and Methods: It was a prospective; blinded; controlled clinical trial comparative study. Both hysteroscopy and 3D USS procedures were done for uterine cavity assessment after failed attempt of ICSI treatment for fifty-two asymptomatic infertile women. Results: Seventeen cases of our studied patients were without intracavitary or cervical lesions. From all studied cases, lesions (n=66) were seen either by hysteroscopy or by 3D USS where lesions (n=24) were seen by hysteroscopy and seen by ultrasound. Lesions (n=34) were seen by hysteroscopy. Lesions (n=36) were seen by ultrasound. Measure of agreement of Kappa was 0.273. Overall sensitivity of 3D USS was 70.59% and specificity 62.50% with positive predictive value (PPV) 66.67% and negative predictive value (NPV) 66.67%, accuracy was 66.67%, positive likehood ratio (LR+ve) 1.88% and negative likehood (LR-ve) 0.47%. The p-value was 0.026, which is statistically significant. Conclusion: It is important to investigate the uterine cavity in infertile women with history of unsuccessful ICSI. 3D USS has a good sensitivity and specificity for diagnosis of uterine cavity abnormalities and it could be used before hysteroscopy as a first line of investigation of intrauterine lesions. | ||||
| Keywords | ||||
| Intracytoplasmic Sperm Injection (ICSI); Repeated implantation failure (RIF); Hysteroscopy; Three-Dimensional Ultrasound (3D USS); Gold Standard; sensitivity; specificity | ||||
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