Diagnostic Accuracy of Transvaginal Ultrasound in the Evaluation of Female Infertility: A Systematic Review

Female infertility can result from issues with the fallopian tubes, uterus, and cervix. Ultrasound has become an essential component of the modern investigation of female infertility and the management of assisted conception, which is able to access endometrial and uterine factors that affect embryo implantation. To date, Transvaginal ultrasound (TVS) has become the modality of choice for the initial study of female infertility since it is widely available, cost-effective, and non-invasive. This study aims to assess the diagnostic accuracy of TVS in evaluating female infertility and how different types of abnormalities in female infertility affect the diagnostic accuracy. The systematic search in this study followed the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-Analyses. The electronic databases PubMed and ScienceDirect were utilized. Papers published between 2012 and 2022 were chosen and subjected to analysis following the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). In the initial search strategy, a total of 217 articles were discovered. By applying specific criteria for inclusion and exclusion, a set of five studies involving 770 patients were chosen for analysis. Forest plot analysis of these five studies evaluating sensitivity and specificity demonstrated low heterogeneity (Q = 4.574) and moderate heterogeneity (Q = 20.771) respectively. Employing a random-effects model, transvaginal ultrasound (TVS) demonstrated a favorable overall accuracy for evaluating female infertility with a pooled sensitivity of 0.79 (95% CI: 0.60, 0.99), and a specificity of 0.96 (95% CI: 0.76, 1.17). The sensitivity and specificity may vary depending on the specific abnormality being assessed. The most observed abnormalities were endometrial polyps and uterine fibroids, while uterine cancer and adenomyosis were the least frequently observed abnormalities. Findings from this study suggest that TVS offers moderate accuracy in the evaluation of female infertility. TVS is particularly valuable when used in conjunction with hysteroscopy, as it demonstrates high accuracy in detecting and characterizing abnormalities.