Saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity in women with unexplained infertility

Abstract

Background Uterine abnormalities, congenital or acquired, are implicated as one of the causes of infertility. Embryo implantation depends on the quality of the ovum, the condition of the endometrium as well as the uterine cavity. Hence, it is recommended to diagnose and treat these abnormalities in patients with unexplained infertility. Objective The aim of this study was to compare the diagnostic accuracy between saline infusion sonography (SIS) and hysteroscopy (HS) to evaluate uterine cavity pathologies among women with unexplained infertility. Patients and methods This study was carried out on 50 women with unexplained infertility in the Department of Obstetrics and Gynecology at Tanta University Hospital, from March 2015 to December 2015. Patients were subjected to an ultrasound assessment of uterine cavity using saline as the contrast medium (SIS) and then followed by HS on a later date. Examination was performed after cessation of menstruation, but before the 10th day of the menstrual cycle (early-proliferative phase of the same menstrual cycle). The uterine cavity was inspected for irregularities such as synechiae, polyps, and submucous myomas, as well as uterine malformations. Sensitivity, specificity, accuracy, and positive and negative predictive values of SIS and diagnostic HS to detect intracavitary abnormalities were compared. Results In this study, HS was more sensitive (100 vs. 85%), with the same specificity (100 vs. 100%), and more accurate (100 vs. 94%) than SIS. HS also had a higher predictive value (100 vs. 100% positive predictive value, 100 vs. 90% negative predictive value) than SIS during the evaluation of patients with unexplained infertility. Conclusion Infertile women should be screened for possible uterine cavity abnormalities. HS is still considered the gold standard to diagnose intrauterine pathology as it is more sensitive and more accurate than SIS. However, SIS has the advantages of being a simple, well-tolerated, noninvasive, cheap, affordable, shorter duration, and accurate method for uterine cavity evaluation. Thus, SIS can be used as an alternative technique for the evaluation of uterine cavity abnormalities when HS is not available.