A COMPARATIVE STUDY OF SONOHYSTEROGRAPHY WITH LAPARASCOPY IN INFERTILE WOMEN WITH OBSTRACTED PROXIMAL OF UTERINE TUBES IN THE HYSTEROSALPANGOGRPHY

Tubal and peritoneal pathology is among the most common causes of infertility (approximately 30-35%). HSG and laparoscopy are the 2 classic methods for evaluation of tubal patency in infertile women and are complementary rather than mutually exclusive; each provides useful information that the other does not and each has both advantages and disadvantages. Compared with laparoscopy as a test of tubal patency HSG has only moderate sensitivity. The clinical implications are that when HSG reveals obstruction there is still a relatively high probability (approximately 60%) that the tube is in fact open. Laparoscopy is more invasive, usually requires general anesthesia, and provides no information regarding the uterine cavity and risks complications including accidental injury to the bowel or blood vessels. Sonohysterography is an accurate screen for patent tubes, reflected in its high positive predictive value compared to lap and dye. Sonohysterography is technically feasible and acceptable for patients in an outpatient setting. Also the patient is not exposed to x-rays or iodinated contrast media and well-tolerated technique that has a low rate of side effects and rare complications. Forty two women with proximal tubal obstruction on the HSG were selected; sonohysterography was performed by instilling saline into the uterine cavity through an intra cervical balloon catheter, there was concurrent vaginal sonographyic visualization in all cases. After sonohysterography showed tubal obstruction, laparoscopy was performed. Tubal obstruction was detected in 8 of 40 sonohysterographic examinations. Six of 8 cases with tubal obstruction were confirmed by laparoscopy. Sonohysterography is an accurate screen for patent tubes. That is a simple, safe and well-tolerated technique that has a low rate of side effects and rare complications.