Routine use of saline hysterosonography in 500 consecutive, unselected, infertile women (original) (raw)
Related papers
Journal of Obstetrics and Gynaecology Research, 2003
Aim: To investigate the accuracy of hysterosalpingography (HSG) in comparison to hysteroscopy in the detection of intrauterine pathology in patients with infertility, where hysteroscopy is the gold standard. Methods: A prospective, comparative study included 336 patients undergoing both HSG and diagnostic hysteroscopy. Main outcome measures were sensitivity, specificity, positive and negative predictive value, and accuracy rate of HSG. Results: Intrauterine abnormalities were shown on HSG in 286 patients and confirmed in 200 at hysteroscopy. Contrarily intrauterine lesions were detected by hysteroscopy in 4 out of 50 patients in whom HSG were normal. The most common intrauterine finding of 336 patients on hysteroscopy were intrauterine adhesions (IUA) (74), followed by endometrial polyps (56), and submucous myoma, 26 patients. Statistical analysis revealed that HSG in the detection of intrauterine pathology had a sensitivity of 98.0%, specificity of 34.9%, positive predictive value of 69.9%, negative predictive value of 92.0%, and accuracy rate of 73.2% with falsepositive and false-negative rates of 30.1% and 8.0%, respectively. The common incorrect diagnoses of HSG were misdiagnosing a condition of cervical stenosis as severe IUA in 24 patients, endometrial polyps as submucous myoma in 22 out of 50 patients, and submucous myoma as endometrial polyps in 12 out of 72 patients. Conclusions: Hysterosalpingography is still a useful screening test for the evaluation of the uterine cavity. If a hysterogram demonstrates intrauterine abnormalities, hysteroscopy should be considered to make a definite diagnosis and treatment. Both procedures should be complementary to each other.
Predictive value of hysteroscopic examination in intrauterine abnormalities
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2004
Study objective: This study was set up to evaluate the predictive value of hysteroscopic examination in patients referred to the Department of Obstetrics and Gynecology at the Medical and Health Science Center, Debrecen, Hungary. Study design: The authors performed 835 biopsies by hysteroscopy over more than 13 years. They compared their findings with histological findings held in a a computerized clinical database. Results: The sensitivity of hysteroscopy was 0.52 for hyperplasia, 0.87 for polyps, 0.85 for myomas, 0.68 for carcinoma, and 0.73 for atrophy. Conclusion: It seems that for findings facing into the uterine cavity (such as submucosal myomas and peduncular polyps), hysteroscopy can predict the histological results. The evaluation of endometrial cycles and of the thickness of the endometrium by hysteroscopy is less accurate.
Ultrasound in Obstetrics & Gynecology, 1998
The availability of advanced hysteroscopic surgical techniques has changed the management of abnormal uterine bleeding. The aim of this study was to evaluate the use of transvaginal sonography (TVS), sonohysterography (SH) and diagnostic hysteroscopy (DH) for the preoperative assessment of the uterine cavity. The plan was to investigate 100 patients with abnormal uterine bleeding despite conventional medical treatment. The endpoints were uterine abnormalities detected by operative hysteroscopy and histology, and subjective estimates of discomfort during TVS and SH. A total of 104 patients (aged 26–79 years) were recruited and 98 (94%) underwent all three diagnostic procedures. Uterine abnormalities were present in 52 patients (53%). There were 25 cases with at least one endometrial polyp, 17 with submucous fibroids, seven with endometrial hyperplasia and three with an adenocarcinoma. The overall sensitivity of TVS improved after SH from 67 to 87% and the specificity from 89 to 91%. The positive predictive value increased from 88 to 92% and the negative predictive value from 71 to 86%. The use of SH also improved the quality of information about the location and size of polyps and submucous fibroids. Increased endometrial thickness associated with adenocarcinoma was detected in all cases (three of three) by TVS and in four of seven cases of hyperplasia (five of seven cases after SH). Most patients reported minor discomfort during TVS or SH and no side-effects were apparent. The sensitivity of DH was 90% (92% for polyps, 88% for fibroids); two cases with a polyp, two with a submucous fibroid and one with endometrial hyperplasia were not detected. The use of saline infusion to enhance visualization of the endometrium increases the diagnostic accuracy of transvaginal sonography to approach that of diagnostic hysteroscopy and also provides some additional information. This development has implications for the management of uterine bleeding disorders. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Hysterosalpingography Vs Hysteroscopy in the Detection of Intrauterine Pathology in Infertility
Journal of Nepal Health Research Council, 2009
Background: This study was to compare the accuracy of hysterosalpingography (HSG) with hysteroscopy (HSC) in detection of uterine pathology in patients with infertility. Methods: This is a prospective comparative study done among 50 new cases of primary and secondary infertility presenting to infertility clinic of Tribhuvan University Teaching Hospital from March 2006 - 2007. HSG was performed in the proliferative phase of menstrual cycle followed by HSC in the proliferative phase of the same or the following cycle. Intra uterine findings on HSG were evaluated and compared with hysteroscopic findings. Results: Out of 50 cases, HSG revealed normal findings in 49 cases (98%) and HSC demonstrated normal uterine cavity in 44 of the cases (88%). There was one abnormality (2%) shown on HSG (subseptate uterus) which was confirmed at HSC. HSC demonstrated six cases (12%) of intrauterine pathologies and these were endometrial polyps, subseptate uterus and submucous myoma. HSG in the detectio...
Medical journal of the Islamic Republic of Iran, 2016
Müllerian anomalies are associated with infertility. Hysteroscopy as the gold standard for evaluating Müllerian anomalies is an invasive, expensive and risky procedure which requires enough experience. Transvaginal sonography (TVS) and hysterosalpingography (HSG) are less invasive procedures, but there is little known about the accuracy of these tests. The aim of this study was to evaluate the accuracy of the combination of TVS and HSG with hysteroscopy as the gold standard. Medical records of infertile women who were undertaken all three diagnostic modalities were reviewed to analyze their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Ninety-nine infertile women were assessed with a mean±SD age of 29.1±6.47 years, mean±SD duration of themarriage of 8.9±10.28 years, and mean±SD duration of infertility of 5.6± 4.16 years. The sensitivity, specificity, PPV, and NPV of TVS were 98.55%, 30%, 76.4%, and 90%, respectively. HSG had a sensit...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Uterine cavity abnormalities are seen as a cause of infertility in around 10%-15% of women. In women with recurrent implantation failure abnormalities are found in up to 50% of the women. 1 Evaluation of the uterine cavity is a basic step in the investigation of infertile women because the most critical step for successful IVF outcome is embryo implantation, which is influenced by a positive cross talk between an adequate quality embryo and a receptive endometrium. 2 Any uterine pathologies such as polyps, myoma, adhesions or congenital malformation can therefore interfere with the implantation process. 3 Thus, it is recommended to diagnose and treat these abnormalities ABSTRACT Background: Uterine cavity abnormalities are seen as a cause of infertility in around 10%-15% and can go up to 50% in women with recurrent implantation failure. Saline infusion sonohysterography (SIS) is a minimally invasive diagnostic modality in the evaluation but hysteroscopy remains the gold standard in the assessment of intra uterine cavity. The aim of this study was to compare the diagnostic accuracy of saline infusion sonography (SIS) considering hysteroscopy (HS) as the gold standard to evaluate uterine cavity pathologies in infertile women at CHRACERH. Methods: Authors carried out a cross-sectional, retrospective study, over 2 years, from the 1st January 2016 to the 31st December 2017, with retrospective data collection in 110 records of infertile patients subjected to an ultrasound assessment of uterine cavity using saline as the contrast medium with a 6.5-MHz transvaginal transducer. When SIS found intra uterine abnormality, HS was done on a later date, using a 5 mm Bettocchi hysteroscope. Sensitivity, specificity, accuracy, positive and negative predictive values of SIS and HS were compared using the SPSS 20 software. Results: The mean age and body mass index were respectively 39.3±7.8 years and 28.7±4.1 kg/m². The main findings both in SIS and Hysteroscopy were respectively polyps (n=61; 55.5% vs 52.7%; n=58), myomas (n=43; 39.1% vs 31.8%; n=35), intrauterine adhesions (n=18; 16.4% vs 21.8%; n=24). The overall sensitivity, specificity and accuracy of SIS were 81.2%, 86.9% and 86.5% respectively. Conclusions: SIS as a diagnostic tool in the evaluation of intrauterine lesions has a good accuracy and can therefore replace HS when this later is not available, especially in our African setting.
Facts, views & vision in ObGyn, 2014
Magnetic Resonant Imaging (MRI) has demonstrated that we can differentiate the uterus in 3 important functional areas. Exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the Junctional zone myometrium (JZ), the outer myometrium and the cervical canal. Especially the JZ myometrium should receive our close attention in the exploration and treatment of the infertile patient. MRI cannot be implemented as a screening examination but also limiting the imaging of the womb to a 2 or 3 D ultrasound exam only does not meet the scientific requirements of sensitivity and specificity. Modern ambulatory uterine diagnosis in a one-stop approach includes transvaginal ultrasound, fluid mini Hysteroscopy, contrast sonography and endomyometrial tissue sampling. Transvaginal Ultrasound being the gold standard for global uterine screening has a cardinal importance for diagnosis of myometrial disorders and uterine congenital malformations whereas hyster...
Gynecological Surgery, 2011
This study was conducted to assess whether women would prefer to undergo saline infusion sonography (SIS) or office hysteroscopy for the investigation of the uterine cavity. In a randomised controlled trial, 100 patients underwent SIS or office hysteroscopy for assessing patients' pain scores. After the investigation, 92 of them were asked to fill out an anonymous questionnaire addressing their preference regarding the method of evaluation and treatment of the uterine cavity. A control group, consisting of 50 women who never underwent SIS or office hysteroscopy, was also asked to complete an identical questionnaire. The questionnaire was completed by 113 women (83.7%). Twenty-four (21.2%) women would opt for SIS, whereas 52 (46.0%) would opt for office hysteroscopy, and 37 (32.7%) had no preference. If therapy would be necessary, 48.7% of the women would opt for an outpatient treatment, whereas 33.0% of the women would prefer treatment under general anaesthesia. Despite the fact that SIS is less painful, the majority of the women prefer office hysteroscopy. Additionally, therapy in an outpatient setting is preferred to a day case setting.
JBRA Assisted Reproduction, 2019
Objective: The aim of this study was to verify the prevalence of uterine cavity abnormalities diagnosed by routine office hysteroscopy in women preparing to IVF. Methods: We carried out a retrospective cross-sectional study of 1141 consecutive women who underwent outpatient hysteroscopy before IVF at a tertiary academic center. Of these, 961 participants had a normal transvaginal sonography (TVS) of the uterine cavity. The prevalence of hysteroscopic alterations in successive age strata was submitted to Mantel-Haenzsel Chi-square test for linear trend. The diagnostic accuracy of TVS using hysteroscopy as reference was assessed by calculating the sensitivity, specificity, positive and negative likelihood ratios. Results: Hysteroscopic alterations were present in 265/961 of patients with a negative TVS (prevalence 27.6%, 95% confidence interval [CI] 24.8%-30.5%). The prevalence of unsuspected submucous leiomyoma was higher among older women (p=0.005, chi-square test for linear trend) and reached 7.2% (95% CI 3.5%-14.1%) after 40 years. The sensitivity of TVS ranged from 8% (95% CI 2%-20%) for uterine synechiae to 41% (95% CI 28%-56%) for submucous leiomyoma, resulting in low likelihood ratios for negative TVS results. Conclusions: These findings suggest a high prevalence of unsuspected alterations found by routine hysteroscopy before IVF, an age-dependent increase in the frequency of submucous leiomyoma and a low diagnostic sensitivity of TVS to detect intracavitary lesions.
Results of 2500 office-based diagnostic hysteroscopies before IVF
Reproductive biomedicine online, 2010
The aim of the study is to assess the diagnostic accuracy, findings and feasibility of office-based diagnostic hysteroscopy in an IVF population. A total of 2500 consecutive infertile patients were enrolled prospectively prior to IVF treatment. Diagnostic hysteroscopy was performed on each subject in an office setting in the study IVF centre. A total of 1927 patients (77.1%) had a normal uterine cavity, while the remainder of the sample (n=573) demonstrated endometrial pathology on hysteroscopy (22.9%). Of the patients with endometrial pathology, 192 patients had endometrial polyps (7.68%), 96 patients had submucosal fibroids (3.84%), 31 patients had polypoid endometria (1.24%), 27 patients had intrauterine adhesions (1.08%) and 73 patients had uterine septa (2.92%). Diagnostic office-based hysteroscopy is routinely performed in the IVF clinic to assess the endometrial cavity. In such an unselected population, a significant percentage of patients had evidence of uterine pathology th...