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 infertility group, out of 16 cases, tubes were patent (U/L or B/L) in 7 (43.75%) cases and blocked (B/L) in 9 cases (56.25%). In the primary infertility group, out of 34 cases, laparoscopy with chromopertubation showed tubal patency in 31 cases (91.18%) and tubal block in 3 cases (8.82%) and out of 16 cases of secondary infertility, laparoscopy with chromopertubation showed tubal patency in 8 cases (50%) and tubal block in 8 cases (50%). 31 patients i.e. 29 TP (patent U/L or B/L) and 2 TN (blocked B/L) had similar tubal findings on saline sonosalpingography and laparoscopy. In 2 patients false negative results were elicited i.e. tubes were blocked on sonosalpingography but patent on laparoscopy. In 1patient we got false positive result i.e. patent tubes on sonosalpingography but blocked on laparoscopy. 15 patients i.e. 7 TP (patent U/L or B/L) and 8 TN (blocked B/L) had similar tubal findings on saline sonosalpingography and laparoscopy. In 1 patient false negative results were elicited i.e., tubes were blocked (B/L) on sonosalpingography but patent on laparoscopy. Out of total 50 cases, 37 cases (74%) showed patent tubes (unilateral or bilateral) i.e. positive test and 13 cases (26%) showed tubal block i.e. negative test. laparoscopic chromopertubation confirmed tubal patency (U/L or B/L) in 39 cases (78%) and tubal block (B/L) in 11 cases (22%). 46 patients i.e. 36 TP (patent U/L or B/L) and 10TN (blocked B/L) had similar tubal findings on saline sonosalpingography and laparoscopy. In 3 patients false negative results were elicited i.e., tubes were blocked on sonosalpingography but patent on laparoscopy. In 1patient we got false positive result i.e. patent tubes on sonosalpingography but blocked on laparoscopy. Out of 11 patients who were confirmed as having tubal block in our study, sono salpingography detected adnexal mass in only 2 patients both of which on laparoscopy proved to be bilateral hydrosalpinx. 9 out of 11 had positive finding on laparoscopy i.e. bilateral hydrosalpinx in 4, adhesions in 3, endometriosis in and bilateral hydrosalpinx and endometriosis in 2 out of 3 false negatives intramural fibroid picked on both transvaginal saline sonosalpinography and laparoscopy. 74% patients on transvaginal sonosalpingography but laparoscopy confirmed it in 78% patients. Although tubal block was seen in 26% patients on transvaginal sonosalpingography, laparoscopy confirmed it in 22% patients in our study. Our results correspond with the study conducted by De Almeida L et al study (2000) 15 , in which 80% patients had patent tubes (unilateral or bilateral) and 20% patients had blocked tubes (bilateral) on transvaginal sonosalpingography and on comparing with laparoscopy it was seen that 83.33% patients had patent tube (unilateral or bilateral) and 16.67% patients had blocked tubes (bilateral). Out of 50 patients, 46 patients had similar findings regarding tubal patency on transvaginal saline sonosalpingography and laparoscopy. These included 36 true positives i.e. patent tubes (unilateral or bilateral) on both procedures and 10 true negatives i.e. blocked tubes (bilateral) on both procedures. Therefore, the accuracy of transvaginal saline sonosalpingography with laparoscopy as the gold standard was 92% and this correlates with many studies including the study done by Nabil M et al (2011) 13 in which diagnostic accuracy of transvaginal saline sonosalpingography was 94.1%. Our results are also comparable with the study done by Junjira Suttipichate et al (2002) 12 where diagnostic accuracy of transvaginal saline sonosalpingography was 95.24%. Likewise Zuo W et al (1996) 16 found transvaginal saline sonosalpingography as 87.1% accurate and Kore S et al 3 (2000) revealed 97% accuracy are consistent with other studies including Junjira Suttipichate et al (2002) 12 in which out of 42 patients, there was one false positive and one false negative. In the study by Seal Subrata Lall et al (2007) 14 , out of 100 patients, there were 2 false positive and 2 false negative on transvaginal saline sonosalpingography.