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

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