Role of 3-Dimensional Sonohysterography in Infertility
Abstract
3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
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Introduction
Infertility is defined by WHO as “inability to conceive after 12 months or more of regular unprotected intercourse by a couple in reproductive age group.”1 It is classified as Primary infertility where no previous pregnancy has occurred and Secondary infertility where at least one pregnancy has taken place irrespective of outcome. Causes of infertility are male factors (30-40%), tubal and peritoneal pathology (30-40%), ovulatory dysfunction (20-40%) and Unexplained factors.
Factors responsible for female infertility are (1) Ovarian factors which includes polycystic ovarian disease, anvolution, diminished ovarian reserve, luteal dysfunction, premature ovarian failure, gonadial dysgenesis. (2) Tubal and peritoneal factors including pelvic inflammatory disease and tubal occlusion (3) Uterine factors including uterine malinformations, uterine fibroid, Asherman's syndrome, endrometriosis, inadequate secretory endometrium, endometrial polyps.
Although evalution for infertility should be offered to all couples who failes to conceive after one year or more of regular unprotected intercourse, but its not mandatory it can be started earlier in certain circumstances. Earlier evaluation is justified for women with irregular mensus, history of pelvic infection or having a male with known or suspected poor semen quality and is also warranted after 6 months of unsuccessful effort by the women over the age of 35 years. 2
The basic methods for evaluation of uterine cavity and tubal patency are Hysterosalpingography, Transvaginal sonography, Saline sonosalpingography, Hysteroscopy, Laproscopy and 3D ultrasound with saline salpingography.
Conclusion
It can be concluded from present study that 3-Dimensional sonohysterography is a practical, easily accessible, acceptable, non-invasive and efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy, which is gold standard for evolution of infertile women. But the later is invasive, requires operative skill and has inherent risk of surgery and anaesthesia. Thus in the hands of skilled practitioner with a good technological basis,3- dimensional sonohysterography can replace the invasive methods, as a preliminary diagnostic tool, in infertility work up and endoscopies reserved for women with abnormal findings in 3DSHG,requiring therapeutic intervention.