The role of saline infusion sonohysterography in the evaluation of infertility

Abstract

Aims: The study aimed to evaluate possible intrauterine pathologies that may not be visible in basal transvaginal ultrasonography in infertile patients using saline infusion sonohysterography. Methods: Between January 2019 and January 2020, 110 patients who presented to the Ankara University Faculty of Medicine, Obstetrics and Gynecology Infertility Polyclinic were enrolled in the study. Saline infusion sonohysterography was performed on primary and secondary infertile patients who were not diagnosed with endometrial pathology via ultrasonography. Results: Pathological findings were detected in 11 out of 110 patients (10.6%) during saline infusion sonohysterography, including polyps, myomas, and adhesions. These patients were referred to hysteroscopy by their practitioner. After the procedure, pathological findings were detected in 54.5% of cases by hysteroscopy. According to these data, the sensitivity of saline infusion sonohysterography in detecting intracavitary pathologies was 60%, specificity was 80.7%, positive predictive value was 54.5%, negative predictive value was 84%, and reliability was 75%. Conclusion: Saline infusion sonohysterography can detect endometrial pathologies not identified by TV USG, suggesting its cost-effective addition to routine evaluations for infertile patients and potential endometrial pathologies.

Keywords

• Saline infusion sonohysterography
• infertility
• endometrium
• ultrasonography

References

1. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007; 22: 1506-12.
2. Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update 2015; 21: 411-26.
3. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med 2012; 9: e1001356.
4. Practice Committee of the American Society for Reproductive M. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2015; 103: e44-e50.
5. Rajkhowa M, McConnell A, Thomas GE. Reasons for discontinuation of IVF treatment: a questionnaire study. Hum Reprod 2006; 21: 358-63.
6. Tarneja P, Duggal BS. Hysteroscopy: Past, Present and Future. Med J Armed Forces Ind 2002; 58: 293-4.
7. Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non‐nvasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016: 2.
8. Izhar R, Mansuri FA, Armar NA, Tahir S. Diagnostic accuracy of Saline Infusion sonohystero-salpingography (SIS) as compared to Hystero-salpingography (HSG) in the assessment of sub-fertile women. J Pak Med Assoc 2019; 69: 777-82.

9. Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 2000; 74: 1029-34.
10. Singh V, Mishra B, Sinha S, Agrawal S, Thakur P. Role of saline infusion sonohysterography in infertility evaluation. J Hum Reprod Sci 2018; 11: 236.
11. Ahmadi F, Rashidy Z, Haghighi H, et al. Uterine cavity assessment in infertile women: Sensitivity and specificity of three-dimensional hysterosonography versus hysteroscopy. Iran J Reprod Med 2013; 11: 977-82.
12. Vitale SG, Haimovich S, Laganà AS, et al. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J Obstet Gynecol 2021; 260: 70-7.
13. Citu C, Gorun F, Motoc A, et al. Hysteroscopy as a primary tool in exploration and treatment of infertility: single center experience in Western Romania. Diagnostics 2021; 11: 1917.
14. Malhotra N, Malhotra JK, Bora NM, et al. Transvaginal Sonography in Infertility. Donald Sch J Ultrasound Obstet Gynecol 2013; 7: 462-74.
15. Moore JF, Carugno J. Hysteroscopy. StatPearls [Internet]: StatPearls Publishing; 2022.
16. Deffieux X, Gauthier T, Menager N, Legendre G, Agostini A, Pierre F. Hysteroscopy: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol 2014; 178: 114-22.
17. Smit JG, Kasius JC, Eijkemans MJC, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet 2016; 387: 2622-9.
18. Yu H-T, Wang C-J, Lee C-L, Huang H-Y, Chen C-K, Wang H-S. The role of diagnostic hysteroscopy before the first in vitro fertilization/intracytoplasmic sperm injection cycle. Arch Gynecol Obstet 2012; 286: 1323-8.
19. Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online 2004; 8: 590-4.
20. Aslam M, Ijaz L, Tariq S, et al. Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci 2007; 1: 17-24.
21. Obajimi G, Ogunkinle B. Routine saline infusion sonohysterography prior to assisted conception: A review of our initial experience. Ann Ib Postgrad Med 2016; 14: 99-102.
22. Radwan P, Radwan M, Kozarzewski M, Polac I, Wilczyński J. Evaluation of sonohysterography in detecting endometrial polyps–241 cases followed with office hysteroscopies combined with histopathological examination. Videosurgery Miniinv 2014; 9: 344-50.