Effectiveness of Sonohysterography in Infertile Patient Work-Up: A Comparison with Transvaginal Ultrasonography and Hysteroscopy

Abstract

Objective: The aim of this comparative study was to evaluate the accuracy of transvaginal ultrasonography (TVU), sonohysterography (SHG) with sterile saline solution compared to hysteroscopy in the diagnosis of intrauterine pathology in a population of infertile patients before an in vitro fertilization (IVF) program. Patients/Methods: 98 infertile patients with a mean age of 33.9 years (range 27–41) underwent TVU assessment and SHG with sterile saline solution immediately followed by hysteroscopy. Results: The clinical findings obtained by TVU, SHG and hysteroscopy were compared. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVU and SHG compared to hysteroscopy were calculated. The TVU sensitivity and specificity compared with hysteroscopy were 91 and 83% respectively. Using TVU, a 9.2% false positive rate (9 cases) and a 5.1% false negative rate (5 cases) were detected compared to hysteroscopy. The TVU PPV and NPV were 85.4 and 90% respectively. SHG yielded better results: sensitivity and specificity when compared to hysteroscopy were 98 and 94% respectively. The SHG PPV and NPV were 95 and 98% respectively. Accuracy of SHG was significantly better than TVU considering all intrauterine pathologies and polyps. Conclusion: In experienced hands, SHG is an easy, safe, and well-tolerated alternative to diagnostic hysteroscopy in the initial evaluation of uterine cavity infertile patients.

Saline infusion sonography in evaluation of uterine cavity abnormalities in infertility: a comparative study

“…10,14,15 The overall low sensitivity of SIS in the present study can be partially explained by high incidence of intrauterine synechiae (36.36%) and their low detection rate by SIS (16.7%). In the present study out of eight patients with intrauterine synechiae five had mild lesions.…”

Hysteroscopic evaluation of uterine cavity in cases of infertility and its correlation with transvaginal ultrasound and hysterosalpingography

“…15 Regarding HSG they found a sensitivity, specificity, PPV and NPV of 98%, 94%, 95% and 98% respectively. The sensitivity of HSG in present study was 90%, specificity of 100%, a PPV of 100% and NPV of 66.6%.…”

Roles of Sonography and Hysteroscopy in the Detection of Premalignant and Malignant Polyps in Women Presenting with Postmenopausal Bleeding and Thickened Endometrium

“…Thus, among the diagnostic methods, hysterescopy gives the highest diagnostic efficacy in detecting endometrial polyps (Elfayomy et al, 2012). It also show great accuracy in diagnosis of focal endometrial pathologies which are hardly recognized by ultrasonography, especially thickenned endometrium that hidden the intracaviter lession (Ragni et al, 2005;Schmidt et al, 2009). Makris et al (2007) showed that hysteroscopy with guided biopsy is the most common comparator for other techniques to diagnose polyps as it offers the highest sensitivity and specificity for conservative measures.…”