Hysteroscopy is Gold standard in Uterine evaluation for Infertility, but HSG still has a place

Abstract

Background: Uterine abnormalities, congenital or acquired are implicated as causal factor in 10%-15% of infertile couplesreporting for treatment. Hysteroscopy, hysterosalpingography (HSG), saline-infusion-sonography and USG are available for evaluation of uterine cavity. HSG helps in initial evaluation of a sub-fertile woman, but hysteroscopy is gold standardas itallows direct visualisation ofintrauterine pathology and treatment in same-setting, if required.
 Aims and Objective: To describe hysteroscopic findings of infertile patients and compare the observations with their respective HSG findings.
 Materials and Methods: It’s a prospective analysis of 105 women with infertility who attendedtertiary-care hospital during 18 monthsfulfilling pre-defined inclusion and exclusion criteria. All cases were evaluated with both HSG and hysteroscopy, observations were recorded and co-related with each other.
 Results: Among 105 cases, maximum (76.19%) were 25-35 years of age. The primary infertility accounted for 68.57% cases.Abnormal HSG findings observed in 19 cases (20%), most common being filling-defect.Hysteroscopy detected abnormalities in 39 cases (37.14%), commonest being endometrial polyp. Out of 39 cases of abnormal uterine cavity detected on hysteroscopy only 19 were picked-up by HSG, rest 20 cases failed to be identified. The strength of agreement between hysteroscopy and HSG calculated is moderate (Kappa=0.505).
 Conclusion: As HSG hadlow false positivity (03%), high positive-predictive-value (90.48%) and negative-predictive-value (76.19%) and high specificity (96.96%) it is still considered as a first-choice screening method of uterine cavity. However, high false-negative-value (51.28%)of HSG makes Hysteroscopy a better diagnostic test. HSG couldn’t differentiate endometrial polyp, adhesions and submucous fibroid, shown them as filling defect only.

Hysteroscopy: An Essential Tool in the Workup of Infertility

“…In our study, no statistically significant difference was there between primary and secondary infertility with respect to uterine cavity abnormalities, similarly observed by Bajaj et al, 8 Latika et al, 11 and Pansky et al 14 The most common abnormal hysteroscopic finding was an endometrial polyp in our study similar to many other studies, and improved reproductive outcomes were reported after polypectomy. Thus it is logical to say that hysteroscopic removal of a polyp is necessary as it may increase chances of conception.…”

“…In our study, no significant difference was found in the number of intrauterine adhesions in cases of primary and secondary infertility similar to the study by Bajaj et al, 8 despite the known fact that adhesions are more common after curettage and postabortal residua.…”

“…9,[11][12][13] Bajaj et al, 8 reported the majority of patients (57.14%) in their study with <5 years of infertility which was similar to the study conducted by Mali and Mohanty, 10 while Amirian et al 9 reported <5 years of infertility in 80% cases whereas in our study 52.2% patients presented with a duration of infertility 5-8 years. Bajaj et al 8 found that out of 105 subjects, normal hysteroscopic findings were seen in 62.86% of women and the abnormal uterine cavity was found in 37.14% of women. Among abnormal hysteroscopy 11 patients presented with congenital uterine defects and 28 patients with the acquired uterine lesion.…”

“…Hysteroscopy was significantly more sensitive than two-dimensional transvaginal ultrasound (2D TVS) for the detection of uterine pathologies in patients with repeated implantation failure and recurrent abortion. There were better detection rates of hysteroscopy in cases of polyps, Asherman's syndrome, and septate uterus as compared to TVS as seen in a similar study conducted by Shiva et al 7 In a study done by Bajaj et al, 8 maximum number of patients belonged to the age group of 25-35 years. Similar findings were found by Amirian et al, 9 Mali and Mohanty, 10 Latika et al, 11 Wadhwa et al, 12 and in our study also.…”

“…In our study, 72.2% of women had primary infertility and 27.8% had secondary infertility. Where in a study by Bajaj et al 8 65.71% had primary infertility and secondary infertility was seen in 34.29% of cases. Similar studies found 70-75% of cases with primary infertility and 25-30% with secondary infertility.…”