Vaginal sonosalpingography in the evaluation of tubal patency

Abstract

During the past few years, sonosalpingography has been suggested as the first-line method to study tubal patency. This study was launched in order to study the applicability of this method at our institution. Thirty-two patients suffering from primary or secondary infertility were evaluated for tubal patency with sonosalpingography using a pediatric Foley urinary catheter and a combination of air and saline solution as a contrast medium. The uterine tubes were evaluated separately and the results were compared to the findings at laparoscopy and chromotubation performed independently. Four patients conceived before their scheduled laparoscopy and were excluded from the study. In addition, the patency of three Fallopian tubes could not be adequately evaluated, leaving altogether 53 uterine tubes that were evaluated by both methods. The findings of both methods agreed in 47 out of 53 tubes (concordance, 88.7%). The sensitivity of sonosalpingography in diagnosing tubal patency was 90.2% and the specificity 83.3%. The positive predictive value for tubal patency by sonosalpingography was 94.9% and the negative predictive value 71.4%. Adverse events of sonosalpingography included moderate to severe abdominal pain in three patients, one vasovagal reaction, and one case of shoulder pain. No infectious complications were recorded. The results confirm that sonosalpingography utilizing air and saline as a contrast medium is a reliable, simple and well-tolerated method to assess tubal patency in an outpatient setting. In addition, the procedure can be performed without prophylactic antibiotics using a regular pediatric Foley urinary catheter instead of an expensive hysterosalpingography catheter.