Evaluation of tubal patency in infertile patients with saline infusion sonosalpingogram


  • Deepa Shanmugham Department of Obstetrics and Gynecology, Aarupadai Veedu Medical College, Pondicherry, India
  • Ramadoss Kabilan Vidhyalakshmi Department of Obstetrics and Gynecology, Aarupadai Veedu Medical College, Pondicherry, India
  • Jessy Varghese Department of Obstetrics and Gynecology, Aarupadai Veedu Medical College, Pondicherry, India




Infertility, Laparoscopy, Sonosalpingogram, Tubal patency


Background: The incidence of tubal disease in infertility in India is as high as 40%. The aim of our study is to evaluate the diagnostic accuracy of Saline Infusion Sonosalpingogram (SSG) in the assessment of tubal patency in infertile patients with laparoscopy as the gold standard.

Methods: This is a prospective study conducted in the department of obstetrics and gynaecology on 50 consecutive infertile patients. Patients with acute pelvic inflammatory disease were excluded from the study. After complete examination and basic infertility work up, the tubal patency testing by Saline Infusion Sonosalpingogram was performed on day 8 of the cycle, followed by diagnostic laparoscopy with chromopertubation to confirm the tubal patency.

Results: Out of 50 enrolled patients, 3 were excluded during the course of study. Thus, the study population comprised of 47 infertile women. During our study, 42 patients had tubes patent on SSG, out of which 41 patients had patent tubes on laparoscopy. 2 patients with blocked tubes on SSG had patent tubes on laparoscopy. 3 patients had blocked tubes on both SSG and laparoscopy. On statistical analysis, the sensitivity of SSG in diagnosing tubal patency is 95.34%, specificity 75%, positive predictive value 97.65% and negative predictive value 60%.

Conclusions: Saline Infusion Sonosalpingogram is a simple, safe, convenient procedure for assessment of tubal patency in infertile women. It can be included in basic infertility work up. Hence, laparoscopy can be reserved for patients with tubal block, suspected pelvic pathology and unexplained infertility.


Laurence AM, Michael RS. Infertility evaluation and treatment. In: Imaging of the Reproductive Tract in Infertile Women: Hysterosalpingography, Ultrasonography and Magnetic Resonance Imaging. WB Saunders Company;1995:300-3. Chapter 23.

Balasch J. Investigation of the infertile couple: investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal. Hum Reprod 2000;15(11):2251-7.

Birmingham Al. Investigation of the infertile couple. Am Fertil Soc. 1992.

Daniel S, Bens A, Ramachandran L. A study of sonosalpingogram compared to laparoscopic chromopertubation in the evaluation of tubal patency. Int J Reprod Contracep Obstet Gynecol. 2016;5(12):4453-60.

Novak E. Berek & Novak's gynecology. Lippincott Williams & Wilkins; 2007.

Shanmugham D, Vidhyalakshmi RK, Shivamurthy HM. The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome. Int J Reprod Contracept Obstet Gynecol 2017;7(1):318-22.

Speroff L, Fritz MA, editors. Clinical gynecologic endocrinology and infertility. lippincott Williams & wilkins; 2005.

Jonathan S Berek. Berek & Novak's Gynaecology. 15th Ed. Lippincott William's and Wilkins; 2012.

Nannini R, Chelo E, Branconi F et al. Dynamic echohyteroscopy. A new diagnostic technique in the study of female infertility. Acta Eur Fertil. 1981; 12(2):165-71.

Richman TS, Viscomi GN, deCherney A, Polan ML, Alcebo LO. Fallopian tubal patency assessed by ultrasound fluid injection. Radiology. 1984;152:507-10.

Randolph JR, Ying YK, Maier DB Schmidt CL, Riddick DH. Comparison of real-time ultrasonography, hysterosalpingography and laparoscopy/ hysteroscopy in the evaluation of uterine abnormalities and tubal patency. Fertil Steril 1986; 46(5):828-32.

Fertility: Assessment and Treatment for People with Fertility Problems. NICE Clinical Guidelines, No. 11. National Collaborating Centre for Women's and Children's Health (UK). London (UK): RCOG Press; 2004 Feb.

Hajishafiha M, Zobairi T, Zanjani VR, Ghasemi-Rad M, Yekta Z, Mladkova N. Diagnostic value of sonohysterography in the determination of fallopian tube patency as an initial step of routine infertility assessment. Journal of Ultrasound Med. 2009;28(12):1671-7.

Lakshmi CS, Sampath K, Vardani P. Evaluation of tubal patency by sonosalpingography is as good as hysterosalpingography in infertile women. International J Reprod Contrace Obstet Gynecol. 2017;6(11):5129-34.

Dasan T A, Basawaraj N G. A comparative study of saline infused sonohysterography and conventional hysterosalpingography in the evaluation of female infertility. West Afr J Radiol 2016; 23(2):124-9.

Ranaweera AK, Batcha M, Kalansooriya H, Ranaweera AK. Research Article Value of sonographic hydrotubation using agitated saline as a screening test for tubal patency. Sch J App Med Sci. 2013;1(2):122-130.

Dwivedi AN, Jain M, Tripathi S, Garg S, Jain S. Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Pathology in Women with Secondary Infertility Taking Laparoscopy as Gold Standard. Surg Sci. 2012;3(08):414.

Pujar Y, Sherigar B, Patted S, Desai BR, Dhumale H. Comparative evaluation of saline infusion sonohysterography and hysterolaparoscopy for diagnosis of uterine cavity abnormalities and tubal patency in infertility: a one year cross-sectional study. J South Asian Fed Obstet Gynecol. 2010;2(2):133-5.

Inki P, Palo P, Anttila L. Vaginal sonosalpingography in the evaluation of tubal patency. Acta Obstet Gynecol Scand. 1998; 77(10):978-82.

Seal Subrata L, Ghosh D, Saha D, Bhattacharya AR, Ghosh S, Mitra S. Comparative evaluation of sonosalpingography hysterosalpingography, and laparoscopy for determination of tubal patency. J Obstet Gynecol India. 2007;57(2):158-61.

Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB. Side effects and complications of sonohysterosalpingography. Fertil Steril. 2003;80 (3): 620-4.






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