Diagnostic capabilities for Müllerian anomalies in women with reproductive disorders

Abstract

Aim:  To determine the frequency and types of Müllerian anomalies (MA) in women with various reproductive disorders and demonstrate three-dimensional transvaginal ultrasound's (3D TVUS) capabilities in MA diagnosis.

Material and methods: A prospective, comparative, case-control study was conducted on 3,973 women aged 16 to 45 between 2019 and 2023. Among them, 2,394 women had primary infertility (Group I), 898 - recurrent pregnancy losses (Group II), 61 - primary amenorrhea (Group III), and 620 women with one or more full-term live births constituted control group (Group IV). All women underwent 2D TVUS and 3D TVUS examinations. Additionally, hysterosalpingography was conducted on 49 women, hystero-laparoscopy on 53 women, and magnetic resonance imaging (MRI) on 30 women.

Results: The most common MA identified in Group I and Group II was a septate uterus. In diagnosing this condition, the 3D TVUS demonstrated sensitivity of 95.83% and specificity of 100% compared to MRI, with Kappa index of 0.978. Compared to hystero-laparoscopy, 3D TVUS exhibited sensitivity of 97.5% and specificity of 100%, with Kappa index of 0.987. Compared to hysterosalpingography, MRI, and hystero-laparoscopy, the 3D TVUS showed 100% sensitivity and specificity for all other anomalies.

Conclusion:  Three-dimentional ultrasonography is a rapid, cost-effective, non-invasive, and highly informative method for evaluating Müllerian anomalies. It demonstrated good concordance with the magnetic resonance imaging method.