An overview of the results of hysterosonography prior to in vitro fertilization

Abstract

ObjectiveThis study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy.MethodsFindings from 197 hysterosonograms of patients examined in an assisted reproduction clinic between January 2012 and August 2014 were included. Enrollment criteria: patients in preparation for IVF not recently submitted to uterine examination through hysterosalpingography or hysteroscopy referred to hysterosonography. Uterine cavity evaluation was considered anomalous when one or more of the following were found: polyps, submucous myomas, uterine synechiae, Müllerian duct anomalies. Individuals with cavity abnormalities that might interfere with IVF results were referred to hysteroscopy.ResultsNormal test results were seen in 170/197 of the cases (86.3%). Eighteen of the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct anomalies. Sixteen of the patients diagnosed with abnormalities underwent hysteroscopy to confirm or treat the suspected pathology. In only two cases there was no agreement between tests: one patient suspected for synechiae and another for polyps were not confirmed; another individual suspected for polyps was found to have focal endometrial thickening in hysteroscopy. The positive predictive value (PPV) in our study was 93.7%.ConclusionIn most cases, the diagnoses obtained by hysterosonography showed normal uterine cavities. The most common anomalous findings were polyps, followed by synechiae, submucous myoma, and Müllerian duct anomalies. Hysterosonography is a good option for evaluating the uterus and offers a high positive predictive value, while hysteroscopy stands as the gold standard.

Evaluation of Uterine Cavity Abnormality using Saline Infusion Sonohysterography Before In Vitro Fertilization

“…From this study, we also found Müllerian duct anomalies in 0.18% of patients. This percentage is similar to another study, with values of 0.5% (Lopes et al 2017) [10]. Sallam (2016) found that saline sonohysterography was diagnostic of the bilateral tubal block with a sensitivity of 100%, a specificity of 91.3%, a PPV of 71.9%, NPV of 93.4%, FPR of 10.2%, and FNR of 7% and also, he found that the pregnancy rate and ongoing pregnancy rate were higher in the group who underwent IVF/ICSI with prior saline sonohysterography than the group who underwent ICSI without a prior saline sonohysterography (49% vs. 36% vs. 37% vs. 26%) [14].…”

“…This finding agrees with the results published in another study, in which 13.3% of 60 infertile women analyzed had abnormalities on SIS (Sitimani et al, 2016) Endometrial polyps were the most frequent pathologic finding in SIS in this study (Figure 1). Our study was similar to other studies reported that endometrial polyps as the most prevalent finding (12.5%) and (9.1%) (Vilela et al 2012 andLopes et al 2017) [10], [11]. Radwan et al (2014) performed a study that included 241 infertile women to evaluate the presence of endometrial polyps.…”

Diagnostic Accuracy Study Comparing Hysterosalpingo-Foam Sonography and Hysterosalpingography for Fallopian Tube Patency Assessment

“…Considering the disadvantages of HSG, hysterosalpingo-contrast sonography (HyCoSy) was introduced as an alternative for outpatient tubal assessment as it avoids the previously mentioned risks. HyCoSy, using a mixture of air and saline solution, has an accuracy comparable to that of HSG [ 7 ], allows the real-time observation of the pelvic organs through ultrasound and it performs better than HSG when detecting abnormalities in the uterine cavity [ 8 ]. However, HyCoSy is more operator-dependent than the two other techniques.…”