Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Pathology in Women with Secondary Infertility Taking Laparoscopy as Gold Standard

Abstract

Context: Secondary infertility is a major public health issue with growing urbanisation and increasing age of marriage among women. Disease limited to low socioeconomic strata is commonly seen in general population. Judicious and accurate assessment of underlying pathology targeting tubes should be undertaken. Aims: The aim of this observational study was to assess the diagnostic accuracy of sonosalpingography taking laparoscopy as gold standard in patients of secondary infertility. Main aim was to assess tubal factors as an underlying cause and to assess feasibility of a radiation free protocol in patients of reproductive age group. Settings and Design: The study was carried out in a hospital setting. A total of 123 patients were selected. Patients of primary infertility were excluded. Sonosalpingography was performed by a single experienced radiologist. This was confirmed by laparoscopy conducted by an experienced gynaecologist. Methods and Material: A detailed clinical and physical examination including internal examination was done. This was followed by sonosalpingography using high frequency TVS probe (Philips IU 22). All patients were subjected to laparoscopic evaluation on the same day. Statistical analysis: Sensitivity, specificity, diagnostic accuracy and predictive values. Results: Sonosalpingography was 72.91% sensitive, 81.33% specific with diagnostic accuracy of 78.05% and positive predictive value of 71.42% for tubal pathologies. Conclusions: Sonosalpingography is a very useful complementary diagnostic modality in assessment of tubal pathology. This should precede direct laparoscopic evaluation. Patients of secondary infertility can be assessed with a combination of sonosalpingography and laparoscopy. This saves the patient of radiation exposure as well as pain of contrast administration