Which infertile women should be indicated for sonohysterography?
OBJECTIVE
To evaluate the indications for transvaginal saline contrast sonohysterography (TV-SCSH) in endometrial screening by transvaginal sonography in infertile women.


METHODS
The study involved 850 consecutive infertile women presenting to an outpatient clinic. Using transvaginal ultrasound endometrial images were evaluated in the proliferative phase. Abnormal images were classified as follows: rugged (R), hyperechoic (H), waved (W), or thick (T). Clinical symptoms such as hypermenorrhea, dysmenorrhea and abnormal uterine bleeding were also recorded. Abnormal endometrial images were further evaluated on TV-SCSH. Age-matched women with normal endometrial images underwent TV-SCSH as controls.


RESULTS
The endometrial pattern was abnormal in 111 patients (13.1%). Lesions that had been identified by TV-SCSH including endometrial polyps (44 cases), submucosal myomata (29 cases), and intramural myomata with mucosal extension (24 cases) were largely associated with the R and/or the H pattern, the W or the T pattern, and the W pattern, respectively. Sensitivity and specificity of the abnormal endometrial image for any lesion were 100% and 91.5%, respectively. Sixty-four patients (59.3%) were asymptomatic despite an abnormal endometrial image.


CONCLUSIONS
TV-SCSH should be performed on selected patients following assessment of endometrial images on transvaginal sonography in order to diagnose intra- and pericavitary lesions in infertile women.
Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan. ando@med.nagoya-u.ac.jp
H
H
Ando
S
S
Toda
M
M
Harada
S
S
Yoshida
I
I
Kondo
T
T
Masahashi
S
S
Mizutani
D000328:Adult; D002404:Catheterization; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D018579:Patient Selection; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014591:Uterine Diseases / Q000000981:diagnostic imaging* / Q000473:pathology