Why 3D transvaginal ultrasound has been adopted into international guidance for fertility workup.
WHO's 2025 Guideline for the prevention, diagnosis and treatment of infertility places saline infusion sonohysterography (SIS) and three-dimensional ultrasound (3D US) at the top of the non-invasive hierarchy for assessing the uterine cavity. It suggests SIS ahead of 3D US mainly on cost grounds, and notes that where 3D US is already available, 3D US may be the preferred option. It also suggests 3D US over two-dimensional ultrasound where resources allow. Both are conditional recommendations based on low-certainty evidence. Hysteroscopy remains the reference standard, but it is invasive and so is not used for routine assessment.
Source: WHO, Guideline for the prevention, diagnosis and treatment of infertility, Geneva, 2025
3D scanning captures the coronal plane, allowing accurate assessment of the uterine outline and cavity shape. This is essential to identify Müllerian anomalies and dysmorphic uterus, which routine 2D scans frequently miss.
Accurate diagnosis of cavity-shape problems changes management: it may direct hysteroscopic correction, alter embryo-transfer planning, or explain prior implantation failures and miscarriages.
We routinely offer 3D-TVUS, often combined with SIS, as part of a thorough infertility workup at LIFE by Dr. Pat.
Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG is a board-certified reproductive endocrinology & infertility specialist, former head of the Vajira IVF unit at Navamindradhiraj University, and founder of LIFE by Dr. Pat in Bangkok. His published research focuses on the dysmorphic (T-shaped) uterus and uterine-factor infertility.
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