The Role of Saline Infusion hysterosalpingography in the Evaluation of Infertility in Tikur Anbessa Specialized Hospital,Addis Abeba, Ethiopia:Cross-Sectional Study.

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Addis Ababa University


BACKGROUND: Female infertility is associated with high incidence of uterine cavity and fallopian tube pathology in developing countries with a high prevalence of STDs, therefore various methods are available for structural evaluation of female reproductive system, among them is saline infusion sonohysterography (SISHG). Objective: This study is designed to asses the role of SISHSG in the evaluation of infertility in area where the gold standard investigation modalities are not readily available. METHODS: A hospital based cross-sectional study was carried out in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia, between January 2019 to August 2019 G.C. SISHSG consists of in-stillation of saline into the endometrial cavity with simultaneous pelvic ultrasonography (US), typi-cally transvaginal US. Fifty consecutive infertile patients referred to radiology unite for SISHSG included in the study. Sensitivity, specificity, positive and negative predictive values were calculated for 26 patients who had both SISHSG and conventional HSG. Data was collected using structured questionnaires, entered and analyzed by SPSS version 23.0 software. Result: A total of 50 patients had undergone SISHSG at the radiology unit for the clinical indication of infertility during the study period. Out of the included patients the majority of the patients were in the age group of 35-40(38%). Thirty four (68%) had secondary infertility and 16(32%) had primary infertility. Eighteen (36%) patients had normal study and the commonest abnormalities detected were 10(20%) myomatous uterus and 7(14%), Asherman syndrome/cervical stenosis followed by 5(10%) bilateral tubal blockage, 2(4%) right hydrosalpinx, 2(4%) chronic endometritis, 1(2%)left hydrosalpinx, 1(2%)right tubal blockage, 1(2%)endometrial polyp, 1(2%) large submucous myoma, as well as one(2%) patient with concomitant PCOS with cervical stenosis and right hemorrhagic ovarian cyst. Among 50 patients, 26(52%) had both SISHSG and conventional HSG study, the sensitivity, specificity, PPV and NPV of SISHSG in normal study, Asherman syndrome/cervical stenosis and chronic endometritis were 100%, 100%,100% and 100% respectively as compared to the gold standard conventional HSG. For bilateral tubal blockage the SISHSG had 50% sensitivity, 90% specificity, 66.7% PPV and 81.8% NPV, however, for unilateral tubal blockage SISHSG had low sensitivity 33%. Conclusion: SISHSG is readily available, easy to do, safe and radiation free procedure and has high sensitivity and specificity in detecting uterine cavity abnormality, we advocate its use as a first step of investigation modality in evaluation of infertility



TVS, SISHG, infertility, TASH.