Objective: Abnormal uterine findings are reported in up to 50% of women with recurrent
implantation failure. Hysterosalpingography is commonly used in evaluation of these
patients. The introduction of saline infusion sonohysterography has improved diagnosis
of endometrial pathologies. Aim of work was to compare accuracy of Hysterosalpingography and Saline infusion sonohysterography in diagnosing uterine pathologies among
infertile women with failed intra-cytoplasmic sperm injection.
Subject & Methods: 118 women with recurrent implantation failure underwent hysterosalpingography and saline infusion sonohysterography. The reports were reviewed and
findings including submucous fibroids, intrauterine septum, synechia and polyps were
compared to those obtained by hysteroscopy. Sensitivity, specificity, and accuracy of procedures were measured.
Results: Regarding submucous fibroids, Hysterosalpingography had sensitivity, specificity and accuracy 80%, 96% and 92.9% respectively, whereas, Saline infusion sonohysterography had sensitivity, specificity and accuracy 95.2%, 98% and 97.5% respectively.
Regarding intrauterine septum, Hysterosalpingography had sensitivity, specificity and accuracy 85%, 95.3% and 93.7% respectively whereas Saline infusion sonohysterography
had sensitivity, specificity and accuracy 89.5%, 97.1%, and 95.9% respectively. Regarding intrauterine synechia, Hysterosalpingography had sensitivity, specificity and accuracy
75.5%, 94.4% and 88.1% respectively. Saline infusion sonohysterography had sensitivity,
specificity and accuracy 70.8%, 97.7%, and 88.1% respectively. Regarding endometrial
polyps, Hysterosalpingography had sensitivity, specificity and accuracy 64.7%, 97.7%
and 85.5% respectively. Saline infusion sonohysterography had sensitivity, specificity
and accuracy 66% and 97.7% and 86.1% respectively.
Conclusion: Saline infusion sonohysterography is comparable, in sensitivity, specificity
and accuracy, to Hysterosalpingography in evaluation of uterine abnormalities.