Retrospective Evaluation of Transvaginal Sonography, Saline Infusion Sonography, and Hysterosalpingography for Detecting Endometrial Polyps in 256 Infertile Women

BACKGROUND Accurate detection of endometrial polyps (EPs), a recognized cause of infertility, is essential prior to in vitro fertilization (IVF). This study compared the diagnostic performance of transvaginal sonography (TVS), hysterosalpingography (HSG), and saline infusion sonography (SIS) for EP detection. MATERIAL AND METHODS This retrospective study included 256 infertile women treated at Acıbadem Maslak Hospital IVF Unit between January 2022 and January 2024. All patients underwent TVS and HSG; SIS was performed in cases with suspected EP. Positive SIS findings were confirmed by diagnostic hysteroscopy, and excised specimens underwent pathological evaluation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical comparisons were made using Cochran's Q test, McNemar's test, and receiver operating characteristic (ROC) curve analysis with DeLong's method. RESULTS The sensitivity and specificity were 60.6% and 52.6% for TVS, 66.8% and 32.0% for HSG, and 94.3% and 28.1% for SIS, respectively. SIS showed significantly higher sensitivity than TVS (P<0.01) and HSG (P<0.01). PPV/NPV were 81.2%/28.3% for TVS, 76.7%/22.0% for HSG, and 81.6%/59.3% for SIS. ROC analysis revealed area-under-the-curve values of 0.566 for TVS, 0.492 for HSG, and 0.612 for SIS, with SIS performing significantly better than HSG (P=0.018). Pathology confirmed that all polyps were functional, and no malignancy was detected. CONCLUSIONS SIS demonstrated the highest sensitivity and diagnostic accuracy, supporting its use as the most reliable non-invasive method for EP detection in infertile women prior to IVF.