Evaluation of Pelvic Pathology of Subfertile Women by Transvaginal Sonography and Correlation with Laparoscopic Findings.

Abstract

Damage of fallopian tube, endometriosis, fibroid uterus, adenomysis and polycystic ovary syndrome are the major pelvic pathology that causes subfertility. Although there are many diagnostic tests available, the clinical presentation of each patient can usually be linked to specific and efficient testing strategies. Transvaginal sonographic (TVS) imaging is an effective, easy to use, safe and readily available noninvasive means to evaluate fertility potential. But in some cases laparoscopic evaluation is mandatory. The study was conducted with an aim to investigate prospectively the role of transvaginal sonography in evaluation of subfertile women. Sixty two patients' transvaginal sonographic and laparoscopic findings were compared to explore the role of TVS as diagnostic tool in infertile women. This descriptive cross sectional type of observational study was done in the Reproductive Endocrinology and Infertility unit, Dhaka Medical College Hospital, Bangladesh from January 2020 to December 2020. Sixty two samples were selected for laparoscopy was taken as purposive sampling. Out of 62 patients 58.0% presented with primary sub-fertility and 42.0% presented with secondary subfertility. Using laparoscopy as the gold standard, TVS showed 100.0% sensitivity and specificity in detection of polycystic ovary and congenital anomaly of the uterus. TVS showed 100.0% sensitivity and 98.3% specificity in the detection of adenomyosis in comparison to laparoscopy. As a test for the detection of fibroid TVS had 87.5% sensitivity, 95.7% specificity and accuracy of 93.6% in comparison to laparoscopy. In detection of chocolate cyst TVS showed good specificity (98.1%) and sensitivity (77.8%) but in cases of hydrosalpinx TVS showed sensitivity only 40.0% in comparison to laparoscopy. The sensitivity of transvaginal sonographic characterization of pelvic adhesion was 6.7% while specificity and positive predictive value were 97.9% and 50.0% respectively. Tubal occlusion was found in 45.0% cases by laparoscopy but TVS failed to evidence this. TVS can be used for the initial investigation of infertile women in cases of congenital anomaly of the uterus, adenomyosis, fibroid uterus and polycystic ovarian syndrome.