Comparative Study of Saline Sono Salpingography (SSG) and Laparoscopy with Chromopertubation in Evaluation of Tubal Patency (original) (raw)
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Background: There has been a drastic increase in the number of cases presenting with infertility and a shift in major causes from ovarian and uterine anomalies to tubal factors. Thus it was necessary to develop better means of evaluation of fallopian tubes. The technological advancements in the field of radiology made it possible to introduce into clinical practice sonographic assesment of fallopian tubes. During the past few years, sonosalpingography has been suggested as the first-line method to study tubal patency. This study was done to know the applicability of this method at our institution. Objective: To compare transvaginal saline sonosalpingography (SSG) with laparoscopy for tubal patency in infertile patients in terms of sensitivity, specificity, positive predictive value (PPV) ,negative predictive value (NPV), false positives, false negatives, diagnostic accuracy, limitations and complications and to detect additional pelvic pathology. Design: Diagnostic test (prospective cross sectional study). Material and methods: Tubal patency of 50 infertile women with previous unknown tubal function was assessed by transvaginal saline SSG on day 7th or 8th of menstrual cycle by injecting 10-30 ml of normal saline solution into the uterine cavity through a pediatric 8F Foleys catheter. The collection of free fluid imaged in the pouch of Douglas or an increased volume of pre existing free fluid were considered as the evidence of at least unilateral tubal patency(positive test). Bilateral tubal obstruction was diagnosed by the absence of fluid collection or static level of fluid in pouch of Douglas( negative test) .Other positive findings were recorded. Diagnostic laparoscopy with chromopertubation was performed in the secretory phase of the same menstrual cycle of the same patient.. Results: The results from transvaginal saline SSG were compared to the findings from the standard diagnostic laparoscopy with chromopertubation. Transvaginal saline SSG had sensitivity, specificity, PPV, NPV and accuracy of 2.31%,90.91%,97.30%,76.92% and 92%. There was 1 false positive and 3 false negatives. Chi. square test detected the difference to be insignificant (p value = 0.74). Transvaginal saline SSG identified abnormal findings in 30 % patients: most common being polycystic ovaries (8%) followed by intramural myoma(6%),adnexal mass (6%),submucous myoma (4%), endometrial polyp (2%),incomplete uterine septum(2%) and simple ovarian cyst(2%). Laparoscopy revealed abnormal findings in 50% patients : most common being endometriosis (12%) followed by hydrosalpinx (10%), polycystic ovaries (8%), functional ovarian cyst (8%) myoma (6%) and adhesions (6%). Adverse events of transvaginal saline SSG included mild pelvic pain during injection of saline through the uterine cavity in 30 patients (60%). This did not, however, result in stopping the procedure or required any medication. No other immediate or remote complication was encountered by either transvaginal saline SSG or laproscopy. Conclusion: The results confirm that transvaginal saline SSG is a simple, well tolerated and reliable screening method for the assessment of tubal patency in an outpatient setting with minimal adverse effect. However, other confirmatory tests are required whenever bilateral tubal occlusion is suspected due to possible false negative findings.
IP Innovative Publication Pvt.Ltd, 2017
Objectives: To find out the comparative evaluation of Sonosalpingography, Hysterosalpingography and Laparoscopy for determination of tubal factors in cases of primary and secondary infertility. Method: A total of 71 patients 45 with primary infertility and 26 with secondary infertility attending our obstetrics and gynaecology department were studied from June 2015 to July 2016. All underwent Sonosalpingography, Hysterosalpingography and Laparoscopic chromopertubation. Chi square tests were used for statistical analysis to find out the sensitivity and specificity of the test. Result: Sonosalpingography has 100% sensitivity and 80.5% specificity in comparision to laparoscopy chromopertubation whereas hysterosalpingography has sensitivity of 94.6% and specificity of 73.1%. Conclusion: As Sonosalpingography has high sensitivity and specificity and is less invasive. It should be used initially to assess tubal patency in case of infertility. Laparoscopy is the best technique for diagnosing tubal and peritoneal disease as it allows direct visualization of all the pelvic organs.
IOSR Journal of Dental and Medical Sciences, 2016
Background: A reliable, safe and cost effective method to asses tubal patency in case of infertility is very essential. Present study was undertaken to compare transvaginal sonosalpingography and chromolaparoscopy for evaluation of tubal patency in infertile patients. Methodology: 50 patients with infertility were subjected to transvaginal sonosalpingography and chromolaparoscopy preferably in a same cycle. All were evaluated for fitness by detailed history taking, general physical examination and systemic examination. Results: Sonosalpingography found bilateral tubal blockage in 30% cases and unilateral blockage in 4% cases on each side. Chromolaparoscopy found bilateral tubal blockage in 28% cases and unilateral blockage in 4% cases on each side. Sensitivity of sonosalpingography was 96.7% and specificity was 87.5%. Positive predictive value was found to be 93.75%. Conclusion: As sonosalpingography has higher sensitivity and specificity and is reliable, simple, cost effective, non invasive and a well tolerated method, it should be used initially to asses tubal patency in case of infertility.
Evidence Based Womenʼs Health Journal, 2015
The aim of this study was to investigate the diagnostic value of transvaginal sonography (TVS) performed after office hysteroscopy, for assessing tubal patency in subfertile women, and to compare the findings with those obtained with laparoscopic chromopertubation. Study design This was a cross-sectional study. Patients and methods TVS was first performed for 60 subfertile women to exclude the presence of free fluid in the pouch of Douglas. Office hysteroscopy was then performed in the outpatient clinic with saline distension medium using 80-100 mmHg pressure, followed by TVS again within 20 min to detect the presence of free fluid in the pouch of Douglas. Laparoscopy with tubal chromopertubation was performed within 1 week for all cases. The results of TVS and laparoscopic chromopertubation were compared. Results The presence of free fluid in the pouch of Douglas after hysteroscopy was correlated to the presence of, at least, one patent tube through laparoscopic chromopertubation; there was a significant statistical difference (Po0.001). The test also revealed a sensitivity of 71.2%, a specificity of 100.0%, a positive predictive value of 100.0%, and a negative predictive value of 34.8%. Conclusion The combination of hysteroscopy and TVS in detecting, at least, one patent tube is a good outpatient method for detecting tubal patency. Nevertheless, it cannot ensure bilateral tubal blockage in case of negative test; hence, another method of tubal patency assessment should be offered.
Fertility and Sterility, 1995
Objective: To evaluate the advantages and accuracy of transvaginal salpingosonography in the assessment of tubal patency with regards to laparoscopic chromopertubation. Setting: Infertility policlinic of the hospital. Design: Thirty-one women suffering from infertility were examined with transvaginal salpingosonography using air and saline as a contrast medium. The results were compared with those obtained with laparoscopic chromopertubation. Results: Altogether 61 fallopian tubes were examined with both transvaginal salpingosonography and laparoscopic chromopertubation. Concordance was 85%. Of the tubes investigated by transvaginal salpingosonography, 45 were found to be patent and 16 were found to be occluded. In chromopertubation, 50 of 61 tubes were patent and 11 were occluded. Bilateral tubal patency was found by transvaginal salpingosonography in 17 cases and by laparoscopy in 22 cases. Unilateral tubal patency was found in 11 and 6 cases, respectively. Bilateral occlusion was found in three cases using either technique. Conclusion: Transvaginal salpingosonography with the combination of air and saline is a low-cost, reliable, safe, and comfortable examination method. It can be used for the primary investigation of infertility on an outpatient basis.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: Tubal problems associated with infertility can be due to blocked tubes, adhesion and scarring of the tubes and distal block leading to Hydrosalpinx. The objective of this study is to evaluate the accuracy and efficiency of Sonosalpingography in the assessment of tubal patency, in comparison to the gold standard method of laparoscopic Chromopertubation and to determine its value as a basic non-invasive screening procedure in infertile women. Methods: A prospective study involving a series of 50 women including both primary and secondary infertility registered in the infertility clinic, Obstetrics and Gynaecology department, at Jubilee Mission Hospital for 1 year (June 2011 to June 2012). These patients after initial evaluation were subjected to sonosalpingography on one of the days between 5th and 10th days of the menstrual cycle for assessment of tubal patency. This was followed by laparoscopy with chromopertubation on the same day or next day. The results of the two tests were compared to determine the accuracy of these SSG. Results: Mean duration of infertility 6-12 years of standard deviation (SD) from mean of 3.72 years. SE<0.4769 and 95% CI was 5.6 to 7.079 yrs. Sensitively for tubal patency with SSG compared to Laparoscopic chromotubation was 93.30% with 95% CI between 84.77 and 96.85. Conclusions: If SSG is performed as a base line test, laparoscopy can be reserved for those women who have unexplained infertility or whose SSG is abnormal or whose medical history and physical examination reveal pelvic pathology.
Human Reproduction, 1997
This study was undertaken to compare two different contrast media (air and Echovist®) in the assessment of tubal patency using transvaginal salpingosonography (TSSG) in 32 infertile women referred to an infertility outpatient clinic. Altogether, 59 Fallopian tubes were examined with TSSG. Laparoscopic chromopertubation was used as a reference method. In group A (air), concordance was 90%, Cohen's kappa coefficient 0.71 [95% confidence interval (CI): 0.64-0.77], sensitivity 63%, specificity 100%, negative predictive value 88% and positive predictive value 100%. In group B (Echovist®), the corresponding parameters were as follows: 93%, 0.71 (CI: 0.67-0.76), 60,100,93 and 100% respectively. No statistically significant differences were found between these two contrast media. Either one can reliably be used for assessing tubal patency with TSSG in infertile women as a primary phase examination modality.
Current methods of tubal patency assessment
Fertility and Sterility, 2011
Objective: To evaluate the scientific literature on current methods of uterine cavity and tubal patency assessment. Design: Review of literature and appraisal of relevant articles using MEDLINE, OVID, EMBASE, and Cochrane on-line databases. Result(s): Current pelvic imaging subfertility investigations are compared with the gold standard laparoscopy. The technical aspects, associated risks, potential advantages, and weighted utility of each screening study are discussed. A comprehensive analysis of the clinical evidence regarding the safety, tolerance, and accuracy of hysterosalpingocontrast sonography compared with alternative screening studies and/or laparoscopy is reviewed. Conclusion(s): Increasing evidence supports the more recently described hysterosalpingo-contrast sonography procedure as an acceptable screening study for the subfertile patient with the potential advantage that it is a comprehensive evaluation, methodologically simple, cost effective, and time efficient.