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Comparison of Hysterosalpingography and Hysteroscopy in Evaluating the Uterine Cavity in Infertile Women

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Comparison of Hysterosalpingography and Hysteroscopy in Evaluating the Uterine Cavity in Infertile Women MOJ Women’s Health Research Article Open Access Comparison of hysterosalpingography and hysteroscopy in evaluating the uterine cavity in infertile women Abstract Volume 8 Issue 1 - 2019 Background: Infertility in women is predominantly associated with uterine cavity Baydaa F Alsannan,1 Ghadeer S Akbar,2 abnormalities. Uterine cavity anomalies and damage to the fallopian tubes may occur 3 due to various reasons such as endometriosis, polyps, adhesions and scar tissues. Anthony P Cheung 1Department of Obstetrics and Gynecology, University of Objective: To investigate the diagnostic value of hysterosalpingography (HSG) in Kuwait, Kuwait comparison to hysteroscopy (HSC) for various structural and intracavitary uterine 2Department of Obstetrics and Gynecology, Ministry of Health, pathologies in women with infertility. Kuwait 3Department of Reproductive Endocrinology and Infertility, Materials and methods: An observational study of 280 women with infertility was University of British Colombia, Canada carried out to compare the diagnostic values of HSG and HSC in the diagnosis of uterine pathologies in women enduring infertility. The specific uterine conditions Correspondence: Baydaa Al Sannan, Department of evaluated were intrauterine synechiae, intrauterine fibroids/polyps and Mullerian Obstetrics and Gynecology, Faculty of medicine, Kuwait congenital anomalies. The main outcome measures were sensitivity, specificity, University, Kuwait, Tel +965 25319601, positive and negative predictive values of HSG relative to hysteroscopy in diagnosing Email the following uterine pathologies: intrauterine synechiae, intrauterine fibroids/polyps Received: December 18, 2018 | Published: January 16, 2019 and Mullerian anomalies. Results: HSG had a sensitivity of 75% in detecting intrauterine synechiae, specificity of 86.5%, positive predictive value of 63% and negative predictive value of 91.8%. For fibroids or polyps, the equivalent values were 82.3%, 40.9%, 56.4% and 71.4%. Finally, for Mullerian congenital anomalies, the corresponding values were 86.6%, 76.3%, 48.1% and 95.7%. The study has indicated that the HSG remains a useful screening test in evaluating the uterine cavity of infertile women. Conclusion: It has been subsequently concluded that HSG remains a valuable screening modality for the evaluation of uterine cavity of infertile women if office sonohysteroscopy or hysteroscopy is not available in absence of tubal pathology. HSG was an ideal procedure to detect intrauterine synechiae, fibroids and to a lesser extent, congenital Mullerian abnormalities. Hysteroscopy should be considered to make a definitive diagnosis and treatment. These two procedures are complementary to each other in evaluation of uterine cavity. Keywords: infertility, hysterosalpingography, hysteroscopy, fibroids, tubal, pathology Introduction Hysterosalpingography (HSG), and Hysteroscopy (HSC). Hysteroscopy (HSC) and Hysterosalpingography (HSG) are used Infertility in women related to uterine cavity abnormalities has for screening purposes in routine infertility evaluation.4 They are been persistent in approximately 34%–62% of infertile women. There used in many infertility centers as an initial investigation tool are a host of reasons that cause female infertility and prevent normal to find the exact cause of the inability to conceive a child. As the conception. Approximately 15% of women enduring infertility suffer name indicates, Transvaginal Sonography (TVS) comprises of a uterine abnormalities, while between 30-40% are shown to have transvaginal ultrasound that examines the reproductive organs of a tubal pathologies as a cause of their infertility. Some of the uterine female that might include the fallopian tubes, cervix, uterus, ovaries abnormalities that are responsible for infertility are intrauterine and vagina. It is a common routine modality that is used to detect 1 adhesions, uterine fibroids and endometrial polyps. Apart from this, the cause of infertility in women. However, uterine abnormalities 20%-40% of women infertility is related to their male counterpart such as submucous fibroids, adhesions and polyps are difficult to 2 and between 20%-40% is found to have ovulatory dysfunction. diagnose with this procedure. Furthermore, transvaginal sonography Comprehensive and detailed evaluation is imperative to explore the shows poor positive predictive value (PPV) rates and poor sensitivity, 3 exact cause of the infertility. Some of the pre-treatment evaluations particularly in the diagnosis of polypoid adhesions.5 include physical examination, hormonal testing and imaging to examine the uterus, endometrium, and fallopian tubes for anomalies Diagnostic hysteroscopy is a safe procedure, which is performed or abnormalities, which might be potentially preventing normal to evaluate the uterine cavity in infertile women and to ascertain the conception. cause of infertility. Hysteroscopy is a diagnostic modality in which the endometrium, which is the inner lining of the uterus; is seen with The standard method for assessing these structures a camera that is placed in the cervix of a patient.6 In addition, it is classically involves a blend of Transvaginal Sonography (TVS), also performed to decide the cause of repeated miscarriages or to help Submit Manuscript | http://medcraveonline.com MOJ Womens Health. 2019;8(1):46‒49. 46 ©2019 Alsannan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Copyright: Comparison of hysterosalpingography and hysteroscopy in evaluating the uterine cavity in infertile women ©2019 Alsannan et al. 47 locate uterine abnormalities such as polyps and fibroids. Hysteroscopy In another study by Phillips13 three diagnostic approaches were is used as a diagnostic, a treatment and a management tool.7 used to compare the uterine and tubal pathologies of infertile women. The three diagnostic procedures were transvaginal sonography, HSG has been the most commonly used investigative technique hysteroscopy and hysterosalpingography. Out of the 1274 patients in the diagnosis of both congenital and acquired intrauterine that received baseline TVS, 327 participants undertook the HSG abnormalities.8 HSG is the examination of a woman’s uterus with the test and out of which, 55 endured the HSC procedure. The results help of an x-ray. However, it employs a different form of x-ray, which revealed that HSC performed better than TVS and HSG with regard incorporates the use of a contrast material. It is performed on women to endometrial abnormalities. On the other hand, HSG outdid HSC for who are having problems in conceiving or are having recurring the diagnosis of tubal obstruction. It was concluded that HSG may not miscarriages. In addition, it is performed to ascertain the existence detect sub-serosal and intramural fibroids. However, it may diagnose of uterine tumors, adhesions and fibroids/polyps. Apart from this, it submucosal fibroids. A study was conducted by Shukla, Yadav & is also used to investigate miscarriages resulting from abnormalities Mishra14 to examine the diagnostic precision of hysteroscopy in within the uterus. Hysterosalpingography is also performed to open relation to vaginal ultrasound and hysterosalpingography in infertile fallopian tubes that are blocked and to allow the probability of future patients. A total of 60 patients participated in the study. The findings pregnancy.9 Therefore, the aim of this observational research study is of the HSG displayed a specificity of 100% and a sensitivity of 90%. to investigate the diagnostic value of hysterosalpingography (HSG) Furthermore, the positive predictive value of the test was 100% and for intracavitary and structural uterine pathologies in comparison a negative predictive value was 66.6%. HSC procedure displayed with hysteroscopy (HSC) in women with infertility. HSC and HSG variations in 65 percent cases that included endometrial polyp, are diagnostic modalities that have been performed in detecting chronic endometritis and synechiae. Apart from this, no complications intrauterine synechiae, intrauterine fibroids/polyps and mullerian occurred after performing hysteroscopy. The results also revealed congenital anomalies. Intrauterine synechiae is a uterine abnormality a moderate agreement between HSG and HSC modalities. It in which intrauterine adhesions are formed. Typically, they are was concluded that HSC showed the most accurate results when a result of a previous injury to the endometrium that can lead to diagnosing small intrauterine abrasions, in comparison to HSG and infertility.10 Intrauterine adhesions are called Asherman’s Syndrome, TVS. Makled, Farghali & Shenouda10 conducted a study to investigate and they happen when the scar tissue forms in the uterine cavity of the role of endometrial biopsy and hysteroscopy in women with the uterus. This results in the binding together of the walls of the inexplicable infertility. Diagnostic hysteroscopy was performed uterus. Intrauterine adhesions are commonly diagnosed with the on a hundred infertile women. The results revealed that 6 patients HSG procedure. Women suffering from pregnancy loss or recurrent suffered from submucous myomas, 6 had cervical stenosis and seven miscarriages (RM) are suspected to be diagnosed with congenital endured intrauterine synechiae. In addition, 15 were diagnosed with uterine anomalies.11 HSG remains a beneficial procedure for the endometrial
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