Diagnostic Performance of Transvaginal Sonography Compared with Laparoscopy in Detecting Pelvic Pathologies among Subfertile Women

Open Access

Abstract

Background: Subfertility affects a significant proportion of couples, with female pelvic pathologies, including polycystic ovaries, ovarian cysts, endometriosis, and peritubal adhesions, being major contributors. Transvaginal sonography (TVS) is widely used as a non-invasive diagnostic tool, while laparoscopy remains the gold standard. This study aimed to compare the diagnostic performance of TVS with laparoscopy in detecting pelvic pathologies among subfertile women. Methods & Materials: A cross-sectional analytical study was conducted on 66 subfertile women aged 18-45 years at BIRDEM General Hospital, Dhaka, from January 2023 to June 2024. Associations between TVS and laparoscopic findings were assessed using Fisher’s exact test, with p-values <0.05 considered statistically significant. All analyses were performed using SPSS version 26. Results: The majority of participants were aged 26-35 years (75.8%), housewives (87.9%), and had primary subfertility (69.7%). Irregular menstrual cycles were common (60.6%), with 43.9% being overweight and 21.2% having thyroid disorders. Polycystic ovaries were the most frequently detected abnormality by both TVS (53.1%) and laparoscopy (56.1%). Ovarian cysts and endometriosis showed comparable detection rates, while peritubal adhesions were detected only by laparoscopy. TVS demonstrated high diagnostic performance for PCOS (sensitivity 94.6%, specificity 100%, accuracy 97%), endometriosis (sensitivity 72.7%, specificity 98.2%, accuracy 93.9%), and ovarian cysts (sensitivity 71.4%, specificity 96.2%, accuracy 90.9%). Sensitivity was low for peritubal adhesions (0%) and tubo-ovarian masses (40%). Conclusion: TVS is a reliable, non-invasive diagnostic tool for detecting polycystic ovaries, ovarian cysts, and endometriosis in subfertile women. Laparoscopy remains essential for diagnosing peritubal adhesions and subtle pelvic pathologies. TVS can serve as an initial screening modality, with laparoscopy reserved for confirmation or cases that are inconclusive.