Authors: S. Sallam (MD)
The aim of this work was to evaluate the diagnostic value of screening Saline Infusion Sonohysterography in diagnosing bilateral tubal blockage in patients with normal transvaginal ultrasonography, before undergoing ICSI treatment and its impact on success rate of ICSI in terms of pregnancy rate, miscarriage rate and ongoing pregnancy rate. In this prospective randomized controlled study, 80 consenting patients with primary or secondary infertility scheduled for ICSI treatment cycle at Dar Elteb infertility Centre, with normal transvaginal ultrasound, were considered eligible for this study after taking an informed consent. The patients underwent ovarian stimulation with standard long protocol. Patients were divided into two groups; Group 1: 40 underwent ICSI with a prior saline sonohysterography and, Group 2: 40 underwent ICSI without a prior saline Sonohysterography. Demographic data of patients included Age (years), Weight (kg) and BMI (kg/m2). Type and duration of infertility in the two groups was also studied. Main outcome measures were; measuring the sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and false negative rate of SIS and TVS as well as the pregnancy rate, miscarriage rate and ongoing pregnancy rate. Comparison of accuracy of TVS and saline sonohysterography in diagnosing the bilateral tubal block was also performed in infertile patients. A total of 80 eligible women were included in the final analysis. Comparison of accuracy of TVS and saline sonohysterography was done in diagnosing bilateral tubal block in the infertile patients. TVS was diagnostic of bilateral tubal block with a sensitivity of 63%, a specificity of 72.5%, a positive predictive value PPV of 60.5%, a negative predictive value NPV of 52.5%, a false positive rate FPR of 29.1% and a false negative rate FNR of 28%. Saline sonohysterography was diagnostic of bilateral tubal block with a sensitivity of 100%, a specificity of 91.3%, a PPV of 71.9%, an NPV of 93.4%, a FPR of 10.2% and a FNR of 7%. Our study results indicated, 49% pregnancy rate, 12% miscarriage rate and, 37% ongoing pregnancy rate in group I (who underwent ICSI with a prior saline sonohysterography) compared to 36 % pregnancy rate, 10% miscarriage rate and 26% ongoing pregnancy rate in group II (who underwent ICSI without a prior saline sonohysterography). There was a statistically significant difference between the two groups as regards the overall pregnancy and ongoing pregnancy rates while there was no significant difference between the two groups as regards the miscarriage rate.
Intracytoplasmic Sperm Injection (ICSI), Embryo Transfer (ET) , Saline infusion Sonohysterography (SIS), Transvaginal ultrasound (TVS)
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