Abstract

Spontaneous pregnancy rate after Saline Infusion Sonogram done under high pressure (SIStreat)

Author(s): Suzan Elsharkawy

Failure to achieve conception after 12 months of regular unprotected intercourse is defined as infertility. 1. As there are so many causes of delayed conception, mostly known and some are still unclear, the tubal factor has increased since the last decade, reached up to 30-35% of cases suffering from subfertility. 2. Checking tubal patency is an essential step in the investigations done for sub-fertile couples and is typically performed using hysterosalpingography (HSG) or laparoscopy with chromotubation. 3. Both HSG and diagnostic laparoscopy (DL) are painful procedures, with well-known hazards of exposure to iodinated X-ray contrast media and ionizing radiation in HSG and possible anesthesia or operative complications in DL. 4. To overcome these disadvantages, during the last two decades contrast sonography (Hy-CoSy) and saline infusion sonogram (SIS) have been used as alternatives in many countries. One advantage of these techniques is the absence of radiation; another is that these procedures can be performed in an outpatient clinic by a gynecologist. Several studies have shown that these methods have nearly equal sensitivity and specificity compared with laparoscopy as the golden standard for tubal patency checking.5,6 Saline infusion sonohysterography (SIS) was first described in 1992 by Bonilla-Musoles et al, its technique entails instilling saline into the uterine cavity under ultrasound guidance; it was mainly used for assessment and better visualization of the uterine cavity.7-9 Recently, SIS was used as the main step for the assessment of fallopian tube patency, because of its simplicity, safety, and high tolerability with a very low risk of complications like; failure to complete the procedure (7%), pelvic pain (3.8%), vagal symptoms (3.5%), nausea (1%), and post-procedure fever (0.8%).10-13 The aim of this study was to evaluate SIS done under high pressure (SIStreat) as a treatment procedure, for relieving simple tubal obstruction and on cumulative pregnancy rate in women suffering from infertility. We hypothesized that SIStreat will open the tubes and increase the spontaneous pregnancy rate in the treatment group.