Sonohysterographic screening before in vitro fertilization

Objective: To evaluate the use of sonohysterography for uterine screening before IVF. Design: Prospective screening with sonohysterography and comparison with available hysterosalpingographic and hysteroscopic evaluations. Setting: Private practice. Patient(s): Seventy-two women undergoing IVF-ET using their own or donor eggs. Intervention(s): Sonohysterography was performed by instilling saline into the uterine cavity through an intracervical balloon catheter; there was concurrent vaginal sonographic visualization in all cases. Main Outcome Measure(s): Sonohysterographic findings and pregnancy rates. Result(s): Cavitary lesions were detected in 8 (11.1%) of 72 sonohysterographic examinations. Six of 8 cases were confirmed and treated by hysteroscopy. After sonohysterographic evaluation, 35 (48.6%) of 72 patients conceived, resulting in 25 ongoing or delivered pregnancies, 5 chemical pregnancies, and 5 spontaneous abortions. No statistically significant difference was observed in the pregnancy outcome for patients undergoing IVF who had sonohysterography compared with that for patients undergoing IVF during the same period who previously had a uterine evaluation by a different method. The estimated cost savings per patient undergoing sonohysterography instead of in-office hysteroscopy was $275. Conclusion(s): Sonohysterography offers advantages over in-office hysteroscopy and hysterosalpingography for evaluation of the uterus before IVF.