Evaluating the Correlation Between Pelvic Magnetic Resonance Imaging and Intra- Operative/Histopathological Findings in Female Infertility at a Tertiary Care Centre

Background: Female infertility has multifactorial pelvic causes, including Müllerian duct anomalies, endometriosis, uterine fibroids, adenomyosis, and tubal-peritoneal disease. Accurate preoperative characterisation is critical for selecting appropriate management and counselling. Pelvic magnetic resonance imaging (MRI) offers high soft‑tissue contrast, multiplanar capability, and comprehensive assessment of uterine, ovarian, and adnexal pathology. This study is designed to evaluate how well pelvic MRI findings align with intra‑operative and/or histopathological (IO/HP) findings in women with infertility at a tertiary care centre. Material and Methods: Setting and design: Prospective observational study at Mahatma Gandhi Medical College and Hospital, Jaipur, following institutional ethics approval and written informed consent. Population: All women meeting the WHO criteria for infertility referred for MRI work‑up. Study period: October 2021 to October 2024. Imaging protocol: Pelvic MRI on a 3.0 T Siemens Vida (S.No. 175971). Core sequences included axial T1-weighted, axial T2-weighted, axial STIR, sagittal T2-weighted, coronal T1-weighted, and diffusion‑weighted imaging (DWI) with corresponding ADC maps, per standardised pelvic protocols. Clinical data collection: Detailed history and relevant laboratory/clinical parameters were recorded. Reference standards: IO findings and/or histopathology, where available, served as the gold standard for correlation. Outcomes: Diagnostic concordance measures (e.g., sensitivity, specificity, accuracy, and agreement) for key etiologies of infertility were planned. Results: MRI evaluation of 50 patients revealed a total of 66 pathologies, with the most common findings being Müllerian duct anomalies (31.82%), fibroids (27.27%), polycystic ovarian syndrome (10.61%), hydrosalpinx (7.58%), and both endometrial polyps and endometriosis (9.09% each). When correlated with operative findings, MRI demonstrated excellent diagnostic accuracy. For fibroids, the sensitivity was 100%, specificity 88.9%, and overall accuracy 92%. In endometriosis, MRI achieved a sensitivity of 83%, specificity of 100%, and accuracy of 98%, while in polycystic ovarian syndrome, sensitivity reached 87.5% with 100% specificity and 98% accuracy. Remarkably, for Müllerian duct anomalies, endometrial polyps, and hydrosalpinx, MRI showed perfect diagnostic performance with 100% sensitivity, specificity, and accuracy. Conclusion: MRI should be prioritised in complex or inconclusive infertility evaluations. It excels in soft tissue resolution and multiplanar anatomical detail. MRI exhibits exceptional diagnostic accuracy and agreement with operative and histopathological findings in evaluating primary female infertility. Keywords: Infertility, Pelvic MRI, Histopathology, Female, Correlation.