Objectives:
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.
Results:
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.
Conclusion:
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.
