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Abstract Uterine cavity abnormalities are seen as a cause of infertility in around 10%-15% of women. In women with recurrent implantation failure abnormalities are found in up to 50% of the women. Therefore, exclusion of intrauterine pathology is an important step before starting ART and is a basic step in female infertility workup and treatment of any discovered lesion may improve ART outcome. Hysteroscopy not only provides accurate visual assessment of the uterine cavity, but also provides a chance to treat any pathology detected during the examination. The availability of hysteroscopes with smaller diameter has made the use of outpatient or office hysteroscopy feasible as a routine examination. Three-dimensional TVS is a non-invasive method for evaluating the uterine cavity. 3D-TVS examines three planes simultaneously, producing a 3D rendering and reconstruction of the coronal plane, both of which are not visible in 2D-US. The aim of the work was to determine the diagnostic accuracy of 3D-TVS compared with hysteroscopy in detecting uterine cavity abnormalities in infertile women. The study was carried out on forty two infertile women recruited from Alexandria Maternity University Hospital between January 2016 to december 2016. All of them were planned for ICSI and fulfilling the required criteria. Our study showed the diagnostic accuracy of 3D-TVS to be 73.81%. 3D-TVS showed sensitivity of 56%, specificity of 100.0 %, positive predictive value of 100.0%, and negative predictive value of 60.71 % with a Negative agreement of 75.56% and a positive agreement of 91.97%. The Prevalence of uterine cavity lesion detected by office hysteroscopy was 59.5% and 33.3% by three dimensional ultrasound. The most common pathology was endometrial polyp (21.4% by OH and 9.5% by 3D US) with others including Sub mucous fibroids (4.8% in both), Adenomosis (4.8% in both), Congenital anomalies (11.9%in both), chronic endometritis(11.9% by OH and 0% by 3D US), Other findings(14.3% by OH and 2.4% by 3D US). |