Diagnostic Comparison of Agitated Saline Sonohysterosalpingography and Hysterosalpingography for Assessing Tubal Patency in Women with Infertility

Background: Tubal disease is the leading cause of female infertility, especially in the developing world.Though HSG is still widely employed as a first-line imaging modality for tubal evaluation, it carries with it the risks of radiation and contrast.Sonohysterosalpingography (Sono-HSG) with agitated saline is less invasive.Methods: A prospective observational study was carried out between October 2015 and June 2017 in the Obstetrics & Gynaecology and Radiodiagnosis departments of Anil Neerukonda Institute of Technology and Sciences, Puducherry.Fifty-four women with primary or secondary infertility aged 20-40 years were evaluated on the same day using both HSG and Sono HSG, followed by laparoscopy if blockage of the tubes was suspected by either test.The performance of both tests was compared in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results: The age of participants was 27 years in the mean and that of infertility was 4.1 years in the mean.Sono HSG was able to detect more uterine and ovarian abnormalities than HSG.Tubal patency was detected in 92.6% of tubes by Sono HSG and 90.7% by HSG.Compared to laparoscopy, Sono HSG had 100% sensitivity, 85.7% specificity, 87.5% PPV, and 100% NPV, beating HSG in specificity and PPV.False positives were lower with Sono HSG.Conclusion: Sono HSG is a cost-effective, safe, and reliable modality for the primary assessment of infertility and could be used as a first-line diagnostic technique in suitably equipped centers.