Hysteroscopy is Gold standard in Uterine evaluation for Infertility, but HSG still has a place

Authors

  • Manisha Bajaj Associate Professor, Gynaecology and Obstetrics Department, ESI-PGIMSR & ESIC Medical College, Joka, Kolkata https://orcid.org/0000-0001-8783-2018
  • Rajib Roy Associate Professor, Gynaecology and Obstetrics Department, ESI-PGIMSR & ESIC Medical College, Joka, Kolkata https://orcid.org/0000-0001-7342-3336
  • Motiur Rahman Consultant, Gynaecology and Obstetrics Department, ESI-PGIMSR & ESIC Medical College, Joka, Kolkata
  • Joydeb Roychowdhury Dean and Director Professor, Gynaecology and Obstetrics Department, ESI-PGIMSR & ESIC Medical College, Joka, Kolkata

Keywords:

Hysteroscopy, USG, Infertility, Uterine Cavity, IVF

Abstract

Background: Uterine abnormalities, congenital or acquired are implicated as causal factor in 10%-15% of infertile couplesreporting for treatment. Hysteroscopy, hysterosalpingography (HSG), saline-infusion-sonography and USG are available for evaluation of uterine cavity. HSG helps in initial evaluation of a sub-fertile woman, but hysteroscopy is gold standardas itallows direct visualisation ofintrauterine pathology and treatment in same-setting, if required.

Aims and Objective: To describe hysteroscopic findings of infertile patients and compare the observations with their respective HSG findings.

Materials and Methods: It’s a prospective analysis of 105 women with infertility who attendedtertiary-care hospital during 18 monthsfulfilling pre-defined inclusion and exclusion criteria. All cases were evaluated with both HSG and hysteroscopy, observations were recorded and co-related with each other.

Results: Among 105 cases, maximum (76.19%) were 25-35 years of age. The primary infertility accounted for 68.57% cases.Abnormal HSG findings observed in 19 cases (20%), most common being filling-defect.Hysteroscopy detected abnormalities in 39 cases (37.14%), commonest being endometrial polyp. Out of 39 cases of abnormal uterine cavity detected on hysteroscopy only 19 were picked-up by HSG, rest 20 cases failed to be identified. The strength of agreement between hysteroscopy and HSG calculated is moderate (Kappa=0.505).

Conclusion: As HSG hadlow false positivity (03%), high positive-predictive-value (90.48%) and negative-predictive-value (76.19%) and high specificity (96.96%) it is still considered as a first-choice screening method of uterine cavity. However, high false-negative-value (51.28%)of HSG makes Hysteroscopy a better diagnostic test. HSG couldn’t differentiate endometrial polyp, adhesions and submucous fibroid, shown them as filling defect only.

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Published

2021-04-01

How to Cite

Bajaj, M., Roy, R., Rahman, M., & Roychowdhury, J. (2021). Hysteroscopy is Gold standard in Uterine evaluation for Infertility, but HSG still has a place. Asian Journal of Medical Sciences, 12(4), 98–104. Retrieved from https://nepjol.info/index.php/AJMS/article/view/35199

Issue

Vol. 12 No. 4 (2021)

Section

Original Articles

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