Hysterosalpingogram (HSG) vs Mid-Cycle Ultrasound (MCUS) in Anatomic Assessment of Infertile Women [32P

Abstract

INTRODUCTION: Utero-tubal anatomic abnormalities represent a very important etiology for primary infertility, and proper evaluation is critical for directed therapy. The most common methods used for evaluation of patients presenting with infertility are: transcervical injection of contrast media with radiography; Hysterosalpingogram (HSG) or transcervical injection of saline with ultrasound; Saline infusion sonography (SIS). However, these methods are painful, costly and can be “non-diagnostic.” Studies show that there is a ten-fold increase in estradiol levels during the mid-cycle. This increases fallopian tube fluid production and endometrial gland thickness, thereby providing a “natural contrast” vs iodinated contrast of HSG. This study proposes that a mid-cycle 2D ultrasound (MCUS) can provide the same accuracy of information as HSG without the pain, cost and potential false findings. METHODS: In the year prior to this study, 153 women with primary infertility underwent both HSG and MCUS during their evaluation at IVF Michigan. The HSG and the dynamic MCUS were performed by a reproductive endocrinologist. The findings of tubal and uterine abnormalities identified with HSG were compared with those identified with MCUS. RESULTS: MCUS identified all distal tubal occlusions with sensitivity and specificity of 100% compared to HSG, and it identified uterine abnormalities with 76% sensitivity and 96% specificity. CONCLUSION: Physician performed dynamic MCUS provides an excellent screening alternative for anatomic assessment of women with infertility and may eliminate the need for invasive testing in this population.