الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Disorders of the uterine cavity and endometrium may have adverse effects on the outcome of conception by interfering with implantation of the embryo. Hence, it is recommended to diagnose and treat these disorders in order to optimize the uterine conditions and subsequent IVF success rates.
TVUS is the standard method applied to screen for possible endometrium or uterine cavity abnormalities in the workup of infertility patients.
Saline Infusion Sonography is reliable, less invasive method and superior to TVUS in evaluation of endometrial cavity.
Hysteroscopy is known as the gold standard procedure for uterine cavity assessment. It is quick, safe and well tolerated by the patients. Therefore it becomes an excellent tool for the diagnostic and therapeutic infertility workup.
This work aimed to assess the diagnostic value of SIS in diagnosis of endometrial pathologies responsible for female infertility.
Fifty infertile female patients (presented by either subfertility or infertility) were referred to the diagnostic imaging and intervention department of Alexandria main and Shatby university hospitals as part of pre-treatment assessment in infertile women.
In the current study the endometrial polyps were found in 5 out of 50 patients (10%) by office hysteroscopy. Only 2 out of 5 endometrial polyps were correctly interpreted by TVUS as focal echogenic endometrial thickness, the remaining 3 patients were misinterpreted as diffuse endometrial thickening (40% diagnostic accuracy). On the other hand SIS succeeded in correct diagnosis of all (5/5) patients having endometrial polyps (100% diagnostic accuracy).
The pseudopolyps had been diagnosed in 2 out of 50 patients forming the current study group (4%). Both cases were correctly interpreted as pseudopolyps by SIS; however TVUS misinterpreted both cases as just diffusely thickened endometrium. Subsequently the diagnostic accuracy of SIS was 100% in pseudopolyps and zero % by TVUS.
Atrophic endometrium has been diagnosed in one out of 50 patients forming the current study group (2%) by office hysteroscopy. The correct diagnosis of atrophic endometrium was reached in this case by both TVUS and SIS (100% diagnostic accuracy).
The submucous fibroids were diagnosed by office hysteroscopy as ivory whitish lesions indenting the endometrial cavity with shiny overlying endometrium in 4 out of 50 patients (8%) forming the current study group. The four cases were correctly detected by TVUS and SIS (100% diagnostic accuracy).
Endometrial adhesions were found to be forming 10% (5/50) patients in the current study group. They could not be seen by TVUS (zero% diagnostic accuracy) because the endometrial cavity should be distended by SIS or office hysteroscopy. SIS succeeded in diagnosis all the five cases (100% diagnostic accuracy)
In the current study the uterine cavity malformations (13 arcuate uterus, 6 T shaped uterine cavity, 5 unilateral T shaped uterine cavity and one unicornuate uterus) were diagnosed only by office hysteroscopy. TVUS and SIS detected only (12/13) arcuate uterus and missed the diagnosis of one case this is attributed to the thickness of the fundal indentation which was less than 5 mm (92.3% diagnostic accuracy).
On the other hand TVUS and SIS failed in the diagnosis of the other congenital uterine anomalies subsequently the diagnostic accuracy of TVUS and SIS was zero %.
The endometritis was diagnosed by office hysteroscopy as pin point erthyematous areas or erthyematous ulcerative patches within the endometrial cavity in 37 out of 50 patients (74%) which could not be detected by TVUS or SIS (zero% diagnostic accuracy).
In the current study, the sensitivity, specificity, PPV, NPV and accuracy of SIS were 51.1 %, 100 %, 100%, 18.5% and 56 % respectively. The low of sensitivity was attributed to the poor detectability of endometritis, unilateral T shaped cavity, T shaped cavity and unicornuate uterus.