Objective To investigate the clinical value of three-dimensional transvaginal ultrasound for evaluating endometrial receptivity and predicting pregnancy outcome in patients with intrauterine adhesions.Methods A total of 116 patients with intrauterine adhesions diagnosed by hysteroscopy in our hospital from January 2019 to August 2020 were selected as the observation group. Sixty healthy women who underwent gynecological examination during the same period were selected as control group. Three-dimensional transvaginal ultrasound was performed on the day of ovulation and after hysteroscopic management of intrauterine adhesions. The endometrial thickness (ET), uterine artery pulsatility index (PI), resistance index (RI), endometrial volume (EV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were measured, and predictive values of these parameters for pregnancy outcome were analyzed.Results Compared with the control group, ET, EV, VI, FI and VFI were lower, while RI and PI were higher in the observation group (P < 0.05). The ET, EV, VI, FI and VFI were lower, but RI and PI were higher in patients with moderate and severe intrauterine adhesions than those in the patients with mild intrauterine adhesions (P < 0.05). Moreover, ET, EV, VI, FI and VFI in patients with severe intrauterine adhesions were even lower than those in patients with moderate intrauterine adhesions, while RI and PI were even higher in patients with severe intrauterine adhesions than those in patients with moderate intrauterine adhesions (P < 0.05). In non-pregnant patients, ET, EV, VI, FI and VFI were lower relative to those in pregnant patients (P < 0.05). The VFI, followed by FI, exhibits the highest sensitivity for predicting pregnancy outcome. However, FI, followed by RI, shows the highest specificity for predicting pregnancy outcome. The area under the receiver operating characteristic (ROC) curve (AUC) of VFI was the highest [0.737 (95% CI: 0.626, 0.847) ], followed by that of FI [0.708 (95% CI: 0.592, 0.825) ].Conclusions Three-dimensional transvaginal ultrasound can evaluate the endometrial receptivity of patients with intrauterine adhesions by measuring parameters including endometrial volume and endometrial blood flow, and is of predictive value for the pregnancy outcome in these patients.