Accuracy of saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity abnormalities in infertile women at CHRACERH, Yaounde, Cameroon

Claude C. Noa Ndoua, Etienne Belinga, Gaspard G. Ayissi Ngah, Junie N. Metogo, Sandrine Mendibi, Jean Marie Kasia


Background: Uterine cavity abnormalities are seen as a cause of infertility in around 10%-15% and can go up to 50% in women with recurrent implantation failure. Saline infusion sonohysterography (SIS) is a minimally invasive diagnostic modality in the evaluation but hysteroscopy remains the gold standard in the assessment of intra uterine cavity. The aim of this study was to compare the diagnostic accuracy of saline infusion sonography (SIS) considering hysteroscopy (HS) as the gold standard to evaluate uterine cavity pathologies in infertile women at CHRACERH.

Methods: Authors carried out a cross-sectional, retrospective study, over 2 years, from the 1st January 2016 to the 31st December 2017, with retrospective data collection in 110 records of infertile patients subjected to an ultrasound assessment of uterine cavity using saline as the contrast medium with a 6.5-MHz transvaginal transducer. When SIS found intra uterine abnormality, HS was done on a later date, using a 5 mm Bettocchi hysteroscope. Sensitivity, specificity, accuracy, positive and negative predictive values of SIS and HS were compared using the SPSS 20 software.

Results: The mean age and body mass index were respectively 39.3±7.8 years and 28.7±4.1 kg/m². The main findings both in SIS and Hysteroscopy were respectively polyps (n=61; 55.5% vs 52.7%; n=58), myomas (n=43; 39.1% vs 31.8%; n=35), intrauterine adhesions (n=18; 16.4% vs 21.8%; n=24). The overall sensitivity, specificity and accuracy of SIS were 81.2%, 86.9% and 86.5% respectively.

Conclusions: SIS as a diagnostic tool in the evaluation of intrauterine lesions has a good accuracy and can therefore replace HS when this later is not available, especially in our African setting.


Hysteroscopy, Saline infusion sonography, Sensitivity, Specificity, Uterine cavity abnormalities

Full Text:



Pundir J, El Toukhy T. Uterine cavity assessment prior to IVF. Womens Health. 2010;6(6):841-8.

Van Voorhis BJ. Ultrasound assessment of the uterus and fallopian tube in infertile women. Semin Reprod Med. 2008;26(3):232-40.

Cakmak H, Taylor HS. Implantation failure: molecular mechanisms and clinical treatment. Hum Reprod Update. 2011;17(2):242-53.

Di Spiezio Sardo A, Di Carlo C, Minozzi S, Spinelli M, Pistotti V, Alviggi C, et al. Efficacy of hysteroscopy in improving reproductive outcomes of infertile couples: a systematic review and meta-analysis. Hum Reprod Update. 2016 J;22(4):479-96.

Bingol B, Gunenc Z, Gedikbasi A, Guner H, Tasdemir S, Tiras B. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy. J Obstet Gynaecol. 2011;31(1):54-8.

Tangri MK, Srivastava AK. Diagnostic accuracy of saline infusion sonography as compared to hysteroscopy in premenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2017;6(2):682-7.

Bernard JP, Rizk E, Camatte S, Robin F, Taurelle R, Lecuru F. Saline contrast sonohysterography in the preoperative assessment of benign intrauterine disorders. Ultrasound Obstet Gynecol. 2001;17(2):145-9.

Amanvermez R, Tosun M. An Update on Ovarian Aging and Ovarian Reserve Tests. Int J Fertil Steril. 2016;9(4):411-5.

Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol. 2015;13(1):30.

Dağ ZÖ, Dilbaz B. Impact of obesity on infertility in women. J Turk Ger Gynecol Assoc. 2015;16(2):111-7.

Pato-Mosquera M, Vázquez-Rodríguez M, Pérez-Adán M, García-García MJ, Blanco-Pérez S. Diagnostic hysteroscopy indications and results in Complexo Hospitalario Universitario De Ourense. Ginecol Obstet Mex. 2013;81(7):382-8.

Draz MH, El-Sabaa TM, Shorbagy SHE. Saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity in women with unexplained infertility. Tanta Med J. 2017;45(3):155.

Nallapati S, Pallavee P, Ghose S. Comparative study of saline infusion sonography and hysteroscopy for evaluation of uterine cavity in abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2017;4(3):828-32.

Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol. 2013;11:118.

Sitimani A, Chawla I, Vohra P. Saline infusion sonography in evaluation of uterine cavity abnormalities in infertility: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2017;5(9):2995-3000.

Seshadri S, El-Toukhy T, Douiri A, Jayaprakasan K, Khalaf Y. Diagnostic accuracy of saline infusion sonography in the evaluation of uterine cavity abnormalities prior to assisted reproductive techniques: a systematic review and meta-analyses. Hum Reprod Update. 2015;21(2):262-74.