Sonohysterography Assessment of the Structural Abnormalities of the Uterus in Women with Infertility in Ethiopia

Background: Female factor infertility is associated with a high incidence of the uterine cavity and fallopian tube pathology in developing  countries with a high prevalence of STDs, therefore various methods are available for structural evaluation of the female reproductive  system, among them is saline infusion sonohysterography (SISHG). The study aimed to assess the role of SISHSG in female infertility  evaluation in areas where the gold standard investigating modalities are not readily available. Methods: A hospital-based cross-sectional study was carried out in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia,  between January 2019 to August 2019 G.C. SISHSG consists of instillation of saline into the endometrial cavity with simultaneous pelvic  ultrasonography (US). Fifty consecutive female patients referred to the Radiology Department for SISHSG are included in the study.  Sensitivity, specificity, positive and negative predictive values were calculated for 26 patients who had both SISHSG and conventional HSG. Result: The majority of the patients were in the age group of 35-40(38%) and 34 (68%) had secondary infertility. The commonest  abnormalities detected were uterine myoma 10(20%), Asherman syndrome/cervical stenosis 7 (14%), and tubal blockage 6(10%). The  sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SISHSG in normal study, Asherman  syndrome/cervical stenosis and chronic endometritis was 100%, as compared to the gold standard conventional HSG. For bilateral tubal  blockage the SISHSG had 50% sensitivity, 90% specificity, 66.7% PPV and 81.8% NPV, however, for unilateral tubal blockage SISHSG had  low sensitivity 33%. Conclusion: SISHSG is readily available, easy-to-do, safe and radiation-free procedure and has high sensitivity and specificity in detecting  uterine cavity abnormality. We advocate its use as a first step of investigation modality in the evaluation of female infertility.