In the investigation of abnormal uterine bleeding, hysteroscopy with endometrial biopsy is considered the gold standard. Fly Thru™ imaging is a new application used to generate virtual hysteroscopy clips.

We aimed to investigate the feasibility and diagnostic accuracy of sonohysterogram with virtual hysteroscopy as an alternative to outpatient diagnostic hysteroscopy.

Materials and Methods
Two separate cohorts of women were recruited. The first cohort was to assess feasibility of the application. The second cohort included women recruited to undergo a sonohysterogram, with virtual hysteroscopy, prior to their scheduled outpatient hysteroscopy. Pain scores were recorded after each procedure.

Sixteen women were recruited to the feasibility cohort and virtual hysteroscopy post‐processing was successfully applied in 14/16 (88%). Clips were produced in less than one minute in 12/16 (75%). Both tubal ostia were identified in 12/16 (75%). Twenty‐nine women were enrolled in the correlation cohort with two women excluded as they did not proceed to hysteroscopy according to study protocol. Virtual hysteroscopy, successfully generated in 23/27 women (85%), detected all intra‐cavitary pathologies (9/27) detected on outpatient hysteroscopy. Tubal ostia were visualised less often with virtual hysteroscopy (37%) when compared with outpatient hysteroscopy (74%). Sonohysterogram with virtual hysteroscopy was associated with less pain with a median difference in pain score of 2 (interquartile range 1.0–4.0, P < 0.0001). Conclusions Sonohysterogram with virtual hysteroscopy is feasible; however, the addition of virtual hysteroscopy to sonohysterogram alone has limited value. Larger studies are required to determine whether it can be used as a diagnostic alternative to outpatient hysteroscopy.