ULTRASOUND DIAGNOSTICS OF INTRAUTERINE ADHESIONS IN INFERTILE WOMEN
Minashkina E.V.1,2, Ozhogina E.V.2, Ozerskaya I.A.3, Alekperova A.F.2
1 - Sechenov University.
2 - Nova Clinic Center of Reproduction and Genetics.
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urpose. To perform a comparative assessment of the diagnostic value of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) in the detection of intrauterine adhesions (IUA) in infertile women, and to identify specific echographic features and anatomical locations of adhesions associated with reproductive dysfunction.
Materials and Methods. A retrospective cohort study was conducted including 103 patients treated at the Center for Reproduction and Genetics «Nova Clinic» between January 2024 and August 2025. All participants underwent 2D and 3D transvaginal ultrasound using a GE Voluson E8 system (USA). Echographic features of intrauterine adhesions were evaluated in standard imaging planes (sagittal, parasagittal, and axial) followed by 3D surface reconstruction using the HDlive mode. Hysteroscopy served as the reference diagnostic standard. Sensitivity, specificity, and accuracy were calculated using McNemar’s chi-square test. In a subgroup of patients, histopathological analysis of the endometrium was performed.
Results. Intrauterine adhesions were hysteroscopically confirmed in 85.4% of the examined women. The 2D-TVUS demonstrated a sensitivity of 54.5%, specificity of 60%, and overall accuracy of approximately 55.3%. The 3D-TVUS achieved a sensitivity of 100% and diagnostic accuracy of 85.4%. The most common echographic findings included endometrial thinning (<6 mm, 43.7%), endometrial asymmetry (17.5%), and the «hourglass» sign (9.7%). Adhesions were most frequently located in the lower uterine third (25.2%), tubal angles, and lateral walls. Histopathological examination revealed inflammatory changes in 60% of cases, predominantly in patients with thin, film-like adhesions.
Discussion. The results confirm that intrauterine adhesions in infertile women predominantly develop following traumatic intrauterine procedures such as curettage, hysteroscopy, or polypectomy, and often remain undetected during conventional 2D ultrasound examination. Three-dimensional echography provides enhanced visualization of adhesions in diagnostically challenging regions – particularly in the lower uterine segment and tubal angles – thereby improving diagnostic accuracy and reducing the rate of missed cases. These findings are consistent with international studies reporting 3D-TVUS sensitivity of up to 97% and specificity between 84% and 91%. The observed correlation between adhesion morphology and inflammatory activity underscores the importance of a comprehensive diagnostic approach that includes morphological verification. The combination of high sensitivity achieved by 3D ultrasonography and the confirmatory value of histopathological analysis establishes a robust foundation for accurate diagnosis and optimal treatment planning.
Conclusion. Three-dimensional transvaginal ultrasound is the most informative noninvasive imaging modality for diagnosing intrauterine adhesions in infertile women. It provides precise visualization of the anatomic location and extent of adhesions, supports preoperative planning of hysteroscopic procedures, and assists in predicting embryo transfer difficulties. Integration of 3D-TVUS into the standard diagnostic algorithm for infertility is strongly recommended to improve early detection of intrauterine pathology and enhance reproductive outcomes.
Keywords: intrauterine adhesions; Asherman’s syndrome; infertility; endometrium; 3D transvaginal ultrasound; echography; reproductive health.
Corresponding author: Minashkina E.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Minashkina E.V., Ozhogina E.V2, Ozerskaya I.A., Alekperova A.F. Ultrasound diagnostics of intrauterine adhesions in infertile women. REJR 2025; 15(4):161-174. DOI: 10.21569/2222-7415-2025-15-4-161-174.
Received: 13.06.25 Accepted: 26.08.25