COMPARATIVE EVALUATION OF TRANSVAGINAL SALINE SONOSALPINGOGRAPHY AND LAPROSCOPY FOR TUBAL PATENCY IN INFERTILITY

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.