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J.C. Kasius1,*, F.J.M. Broekmans1, S. Veersema2, M.J.C. Eijkemans3, E.J.P. van Santbrink4, P. Devroey5, B.C.J.M. Fauser1 and H.M. Fatemi51Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands 2Department of Reproductive Medicine and Gynecology, St Antonius hospital, Nieuwegein, The Netherlands 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands 4Department of Reproductive Medicine and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands 5Department of Reproductive Medicine, Academic Hospital at the Dutch-speaking Brussels Free University, 1090 Brussels, Belgium *Correspondence address. Fax: +31-887555433; E-mail: j.c.kasius{at}umcutrecht.nlReceived July 14, 2010. Revision received December 15, 2010. Accepted January 5, 2011. BACKGROUND Hysteroscopy is known as the most accurate test for diagnosing intrauterine pathology. To optimize fertility treatment, it is increasingly common to perform hysteroscopy as a routine procedure prior to IVF. However, literature on the reproducibility of screening hysteroscopy is lacking. Therefore, the aim of the study was to assess the intra- and inter-observer agreement in the individual evaluation of the uterine cavity using video recordings of hysteroscopy procedures in asymptomatic patients prior to IVF. METHODS Screening hysteroscopies of 123 unselected, asymptomatic, infertile women with an indication for IVF/ICSI treatment were recorded on DVD. After editing, the hysteroscopy performer and three other experienced gynecologists independently assessed all recordings, focusing on the appearance of predefined intrauterine abnormalities (i.e. endometrial polyps, myomas, adhesions or septa). The intra- and inter-observer agreement was calculated and expressed as perfect agreement and ? coefficient or intraclass correlation coefficient. RESULTS In total, 123 hysteroscopy procedures were recorded. After editing and selection, based on the record quality, 107 remained for assessment and analysis. The intraobserver agreement on the appearance of any of the predefined intrauterine abnormalities was substantial (? = 0.707), whereas the interobserver agreement was moderate (? = 0.491). Perfect agreement occurred only in 77.6% of the cases. CONCLUSIONS Interobserver agreement among experienced gynecologists appeared to be rather disappointing. The latter may have implications for the diagnostic accuracy of screening hysteroscopy prior to IVF, as well as for its clinical significance in IVF programs. © The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com This ArticleHum. Reprod. (2011) 26 (4): 801-807. doi: 10.1093/humrep/der003 First published online: February 9, 2011Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.
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