Diagnostic accuracy of Saline Infusion sonohystero-salpingography (SIS) as compared to Hystero-salpingography (HSG) in the assessment of sub-fertile women

Objectives: To compare the sensitivity and specificity of saline infusion sonohysterography with hysterosalpingography as diagnostic tool in the assessment of infertile women. Methods: The comparative cross-sectional study was carried out at a private infertility clinic in Karachi, and comprised women who registered for assessment of infertility from June 2011 to May 2013. Uterine and tubal pathology was assessed as a possible cause of infertility by using saline infusion sonohysterography as an index test and hystero-salpingography as the standard reference. The diagnostic accuracy of the two tests was compared. Sub-fertile patients were followed up for 2 weeks after the tests for any possible adverse effects of the procedures. Data was analysed using SPSS 19. Results: Of the 256 subjects, 184 (72%) presented with primary and 72 (28%) with secondary infertility. Overall mean age of the sample was 28 +/- 8 years. The mean BMI was 29.8 +/- 4.1 in primary infertile compared to 28.2 +/-.5 in women with secondary sub-fertility. The sensitivity of saline infusion sonohysterography for detecting patency of the tubes was 100% and the specificity was 91% whereas positive predictive value was 69.8% and negative predictive value was 100% (Kappa: 0.61). For large uterine polyps, sensitivity and specificity was 100% and for small polyps sono-hystero-salpingography showed 14% false positive results (Kappa: 0.21). Conclusion: Saline infusion sono-hysterography was found to be a more reliable method of diagnosing tubal or uterine pathologies compared to hystero-salpingography for cases of infertility.