Saline infusion sonohysterography: Including evaluation of tubal patency with hysterosalpingo-contrast sonography

For the identification and assessment of uterine lesions, saline infusion sonohysterography seems to be as effective, and in many circumstances, superior, to laparoscopy or hysteroscopy [114,115]. The use of three-dimensional ultrasound aids the diagnosis of congenital abnormalities as efficiently as other methods, such as magnetic resonance imaging, hysterosalpingography, or laparoscopy [116]. The SIS procedure is a quick and minimally invasive procedure that can be performed in the physician's office with little patient discomfort. SIS provides details of soft tissue structures as well as of the shape of the uterine cavity. This technique allows a detailed study of the uterine cavity in cases of infertility, amenorrhea, uterine anomalies, and inadequate or abnormal endometrial images. In the future, SIS that is performed with ultrasound contrast media may replace HSG evaluation for patients with infertility. Also, as the technology advances, sonohysterographic-guided biopsy and excision may become possible as well. SIS is easily learned and requires little additional expenses to offices that provide ultrasound services. As with any technique, no single procedure can replace our full arsenal of diagnostic choices and the decision to perform SIS must be individualized to patient selection, physician preference, and experience. Transvaginal color Doppler sonosalpingography that uses air and saline as a contrast medium is a reliable, simple, and well-tolerated method to assess tubal patency in an outpatient setting [91]. HyCoSy could be used to screen infertile women, thereby avoiding the use of iodinated contrast medium and exposure to ionizing radiation during conventional HSG in patients with patent fallopian tubes. The additional use of color Doppler is recommended as a supplement to gray scale imaging in cases of suspected tubal occlusion [93].