Saline instillation sonohysterography test after normal baseline transvaginal sonography results in infertility patients. Is it justified?

Purpose. To investigate whether there is additional value for saline instillation sonohysterography (SIS) as a routine screening tool when baseline transvaginal sonography (TVS) is normal. Methods. Two-hundred ninety four infertility patients underwent baseline TVS and were categorised according to the results. TVS findings were negative in study group (n=124) and positive (any abnormalities) in control group (n=170). All the patients were further investigated by SIS. Hysteroscopy was performed whenever SIS results were suspicious. Our main outcome measure was accuracy of SIS in detecting intracavitary lesions using pathology reports as gold standard. Results. In the study group, out of 124 SIS tests, 13 (10.4%) showed positive findings and were further investigated by hysteroscopy. Three out of the 13 (23.0%) had subsequent positive hysteroscopy findings, however, no (0.0%) abnormality was found on pathologic examination. In the control group, out of 170 SIS tests, 62 (36.4%) showed positive findings, and were further investigated by hysteroscopy. Forty-two cases out of the 62 (67.7%) had subsequent positive hysteroscopic findings. Pathological examination was positive in 35 out of the 42 (83.3%) positive hysteroscopies. Conclusion. Routine SIS for patients with normal TVS did not contribute additional findings. However, in patients with any suspicious findings on TVS (including extracavitary lesions), SIS was beneficial.