Complementary roles of hysteroscopy and saline infusion hysterosonography in uterine cavity assessment before in-vitro fertilization

Abstract

Objectives The aim of this study was to assess the role of saline infusion hysterosonography (SIHS) in refining the diagnosis of uterine cavity abnormalities by hysteroscopy in infertile, asymptomatic women before IVF/intracytoplasmic sperm injection (ICSI) treatment. Study design This was a comparative study carried out at the Ahmadi Hospital-Kuwait Oil Company during March 2010 to March 2012. Patients and methods A total of 124 asymptomatic, infertile women were included in this study before undergoing IVF/ICSI treatment. An informed consent and approval of the study protocol by the ethical committee of the institute was obtained. Hysteroscopy was performed as a routine procedure for uterine cavity assessment before the first attempt at IVF/ICSI treatment. The patients agreed to undergo an ultrasonographic assessment of the uterine cavity with the use of saline as the contrast medium (SIHS) besides hysteroscopic assessment. Both hysteroscopy and the SIHS procedure were scheduled after menstruation during the early-mid follicular phase of the same menstrual cycle, 1–3 months before starting the IVF/ICSI treatment. Results Uterine cavity abnormalities were detected in 40.3% of the patients included in this study before IVF/ICSI treatment (17.7% had endometrial polyps, 10.5% had submucosal fibroids, 4.8% had a uterine septum, 3.2% had uterine adhesions, 2.4% had endometrial hyperplasia, and 1.6% had a thin or atrophic endometrium). In this study, hysteroscopy was more sensitive (98 vs. 96.2%), specific (100 vs. 98.7%), and accurate (99.2 vs. 97.6%) compared with SIHS. Moreover, hysteroscopy had higher predictive values (100% positive predictive value and 98.7% negative predictive value vs. 98% positive predictive value and 97.4% negative predictive value) compared with SIHS during uterine cavity assessment before IVF/ICSI treatment.