Evaluation of Uterine Cavity in Infertile Women: Comparison of Transvaginal Ultrasound, Saline Contrast Hystero-Sonography and Hysteroscopy—A Tunisian Series

摘要

The development of uterine pathologies usually involves transvaginal ultrasonography, possibly supplemented by hysteroscopy. Recent technical developments in ultrasound have given rise to a new exploration technique: hysterosonography or ultrasound with contrast enhancement. Hysterosonography has emerged today in the study of the uterine cavity with a precise analysis of the endometrial mucosa and related pathologies. Objectives: To determine the contribution of hysterosonography in uterine cavity pathologies, and appraise the performance of this examination in the evaluation of the uterine cavity by comparing it to vaginal ultrasound and diagnostic hysteroscopy. A retrospective study of 39 hysterosonography examinations was performed in the Gynecology and Obstetrics Department of Farhat Hached University Hospital Center, Sousse, Tunisia. Included in the study were patients suffering from infertility. During the period of the clinical trial, 39 patients were potential candidates for this study. The mean age of the patients was 31.5 years. In case of hypofertility associated with endometrial polyps, the hysterosonography/histology concordance was of 51.4% (13/24). The statistical values of the hysterosonography were: sensitivity: 76.9%, specificity: 27.2%, VPP: 55.5%, and VPN: 50%. In case of uterine malformation, hysterosonography allowed the diagnosis to be made in three cases, with a sensitivity of 100%, but the number of these abnormalities was limited and the statistical value was low. In clinical practice, combining hysterosonography with transvaginal ultrasound may increase the sensitivity of the latter, thus avoiding unnecessary diagnostic hysteroscopies. It is likely to significantly reduce the indications for diagnostic hysteroscopy, a test that is not devoid of morbidity.