Screening Sonohysterography in Infertility

Abstract

This prospective comparative study was carried out to assess the value of sonohysterography (SHG) in evaluating both the endometrial cavity and tubal patency in infertile patients and to compare its results with hysterosalpingography (HSG), diagnostic hysteroscopy and laparoscopic chromopertubation. It comprised 84 infertile women who were examined using SHG the day before combined diagnostic laparoscopy and hysteroscopy. Eighty-three patients had had HSG within 6 months. As regards the appearance of the endometrial cavity, the results of SHG agreed with hysteroscopy in 72.2% (k = 0.31) while HSG agreed with hysteroscopy in 75.6% (k = 0.39) of cases. The appearance of the right and left tubes using SHG agreed with laparoscopy in 72.4% (k = 0.16) and 60.5% (k = 0.13), respectively, while HSG agreed with laparoscopy in 94% (k = 0.52) and 90.4% (k = 0.51), respectively. However, when the appearance of fluid in DP was considered as an indirect indicator of patency of at least one tube at SHG, the agreement with laparoscopy rised to 88.1% (k = 0.24) and 85.7% (k = 0.18) for both tubes respectively. In conclusion, SHG is similar to HSG as regards the appearance of the endometrial cavity but it is inferior to it for evaluating tubal factor. The implication of SHG in the infertility work-up as a simple and fast procedure can minimize costs and abuses of sophisticated techniques particularly in the developing countries with limited resources.

Reconstructive Endoscopic Myomectomy

“…There is no doubt that any cavity-distorting myoma should be removed whether completely submucous or interstitial myoma with submucous encroachment. This highlights the central role of prior hysteroscopy as well as saline infusion solonhysterography (SIS) as previously described (84). Controversy exists for interstitial and subserous myomata.…”

Endoscopic Explanation of Unexplained Infertility

“…Saline infusion sonography (SIS) is an attractive alternative to HSG as it is a methodologically simple, cost effective, and time efficient comprehensive evaluation [31]. In 1999, we described a simplified technique of SIS utilizing a simple Nelaton catheter and 0.09% saline [32]. Despite its wide spread usage in many clinics, the main drawbacks of SIS are failure to localize the side of tubal patency and failure to properly visualize the tubes.…”

“…Unexplained infertility is infertility that is idiopathic in the sense that its cause remains unknown even after basic infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman. The available diagnostic tools for intrauterine causes of infertility include transvaginal ultrasonograogy, hysterosalpingography (HSG) or sonohysterography [67]. Manifest uterine causes may include clinically symptomatizing uterine infections, intrauterine adhesions, polypi or uterine cavity malformations.…”

Minimally invasive surgical management of symptomatic uterine cysts

“…Most of these abnormalities can be easily diagnosed utilizing conventional 2D transvaginal ultrasonography with or without saline infusion [1]. On the other hand, uterine cysts are rarely seen with no reported incidence in medical literature and usually accidentally detected by ultrasonography.…”

“…Comment on its size, fluid content, and borders were also reported. In case of suspicion, saline infusion sonohysterography (SIS) was performed in the same manner as previously described [1]. The couple was counseled for interventional 2D transvaginal sonographic aspiration of the cyst aiming at relief of the symptoms.…”