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Sunday, March 4, 2012

Sonosalpingography vs. Hysterosalpingography

This study was conducted to bring into focus the value of pelvic sonograms in assessing tubal patency in order to overcome the radiation hazard associated with hysterosalpingogram (HSG), reduce the cost of examination and encourage it as first – line office based procedure for the diagnosis of female infertility. Hence the present study was undertaken to evaluate uterine outline and tubal patency in infertile patients by transvaginal sonosalpingography (SSG) and to compare it with HSG.
50 infertile patients undergoing routine infertility investigations were selected randomly who agreed to participate in the study.  Within three – four months before or after hysterosalpingography, sonosalpingography was performed. The uterus and tubes were identified using a 6.5 MHz vaginal ultrasound probe and around 10 – 20 ml of normal saline was injected into the uterine cavity through an endocervical catheter. In addition, the procedure was performed with prophylactic antibiotics
Main outcome measures:
The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before or after the injection of saline and the presence of free fluid in the pouch of Douglas.
Most of the cases studied were between the age group of 25-30yrs (51 percent), and the mean duration of infertility was around 6-10 yrs (39 percent).  Sonosalpingography revealed bilateral patent tubes in 60 percent cases, and the remaining 40 percent cases showed either bilateral or unilateral block of the tubes. The sonographic and hysterosalpingographic findings were similar in 94% of the women with respect to uterine assessment and in 81% with respect of tubal findings. The sensitivity of sonosalpingography in diagnosing tubal patency was 85% and the specificity 84%. Adverse events of sonosalpingography included mild to moderate pelvic pain was noted in 6 patients. Infectitious complications was not revealed.
The results confirm that sonosalpingography utilizing saline as a contrast medium is a reliable, inexpensive, simple and well-tolerated method to assess tubal patency in an outpatient setting.
Sonographic hysterosalpingography is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and the fallopian tubes. Its use will reduce the need for hysterosalpingography. 
However, in case where surgical interventions had taken place HSG may still prove useful.