الفهرس 
Review of literatureOnly 14 pages are availabe for public view
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Abstract
Infertility is a problem of global proportions; worldwide more than 70 million couples suffer from infertility. Tubal factor infertility is a common problem. Tubal dysfunction is responsible for approximately 30% of infertility cases.The major concern is to schedule the investigations, especially invasive techniques as laparoscopy, at a time where their benefits will outweigh any associated risks.Various methods exist for the evaluation of tubal patency and tubal integrity as a key component of the diagnostic work-up in infertile couples. These include: hysterosalpingogram, and Sonohysterography. Sonohysterography can be provided in an outpatient setting, and it is associated with minimal patient discomfort and a low risk of infection. This procedure is noninvasive and rather easy to perform in almost any medical setting because it does not require sedation or anesthesia, nor does it have any adverse effects or severe related complications.Summary and Conclusions Diagnostic laparoscopy is the standard means of diagnosing the tubal pathology, peritoneal factors, endometriosis and intra-abdominal causes of infertility. Not only does this help in identification of unsuspected pelvic pathology but also contributes to decision making of infertility treatment.Sixty one infertile patients who were recruited from gynecologic infertility outpatient clinic who underwent saline infusion sonohysterography then laparoscopy for detection of tubal patency.The aim of the present study was to evaluate the accuracy of saline infusion onohysterography in assessment of tubal patency in infertile women in comparison to laparoscopy.The procedure of saline infusion sonohysterography was performed during the follicular phase of the menstrual cycle, transvaginal ultrasonography was performed to exclude the presence of fluid in the douglas pouch before SIS. Instillation of sterile saline through Foley’s catheter using a sterile syringe was performed under sonographic guidance, The collection of fluid in the douglas pouch after the procedure was considered an indicator of patency of at least one or both of the fallopian tubes.Summary and onclusions The laparoscopic examination was performed under general anesthesia, during the follicular phase of the menstrual cycle, testing for fallopian tubes patency was done using methylene blue dye injected using cervical cannula and the spilling of the dye through the fimbrial ends of the tubes was noticed.In the current study there was no significant statistical differences between the infertile patients with patent both tubes, patients with blocked both tubes and patients with blocked one of the tubes regarding the age, weight, BMI, type or duration of infertility.The results of this study showed that the accuracy of HSG and saline sonohysterography in diagnosis of bilateral tubal patency in the infertile patients was as shown. HSG was diagnostic of bilateral tubal patency with a sensitivity of 91.5%, a specificity of 100%, a PPV of 100%, an NPV of 77.8%, an FPR of 0% and an FNR of 8.5%.Saline sonohysterography was diagnostic of bilateral tubal patency with a sensitivity of 95.7%, a specificity of 50%, a PPV of 86.5%, an NPV of 77.8%, an FPR of 50% and an FNR of 4.3%.Summary and Also the results of this study showed that accuracy of HSG and saline sonohysterography in diagnosis of bilateral tubal block in the infertile patients was as shown. HSG was diagnostic of bilateral tubal block with a sensitivity of 100%, a specificity of 94.6%, a positive predictive value [PPV] of 62.5%, a negative predictive value [NPV] of 100%, a false positive rate [FPR] of 5.4% and a false negative rate [FNR] of 0%. Saline sonohysterography was diagnostic of bilateral tubal block with a sensitivity of 100%, a specificity of 92.9%, a PPV of 55.6%, an NPV of 100%, an FPR of 7.1% and an FNR of 0%.
Conclusions:In conclusion of our study we found that saline infusion sonohysterography offer much less invasive method than laparoscope for the diagnosis of tubal patency. Saline infusion sonohysterography also can be performed initially to infertile patients. It is simple, fast, safe, well tolerated, inexpensive procedure avoiding anesthesia complications and associated with rare adverse effects.Summary and Laparoscopy with chromopertubation is widely accepted as the gold standard method for evaluating of internal pelvic organs and tubal patency. It has the ability to simultaneously evaluate the abdominal cavity and other pelvic structures for an enhanced diagnostic evaluation of other etiologies of sub fertility. On the other hand it has operative risks, expensive, more time consuming and the patient needs a period of postoperative recovery.