Role of sonosalpingogram in correlation to hysterosalpingogram in assessment of infertility

Rajneesh Madhok, Vichi Taneja


Background: This study was performed to evaluate the patency of fallopian tubes with hysterosalpingographyand sonosalpingographyin females with complaint of infertility and to correlate the results of sonosalpingogram with that of hysterosalpingogram in assessment of tubal patency in infertility.

Methods: Females with complaint of infertility were evaluated by HSG (Hysterosalpingography) and SSG (Sonosalpingography) between 7th and 12th day of menstrual cycle. HSG was carried out using Siemens fluoroscopy machine. The flow of contrast was followed and tubal patency was assessed. SSG was carried out using Siemens ACUSON X300, with transvaginal probe (4-9MHz). Normal saline was infused slowly and the endometrial cavity was evaluated. Then color flow was used to evaluate each of the adnexa for free spillage of saline (waterfall sign) and results of both the techniques were correlated.

Results: Altogether 94 tubes were evaluated by HSG & SSG each. On HSG, out of 94, 65 tubes were patent and 29 tubes showed blockage. On SSG, 68 tubes were patent and 26 tubes showed blockage. Results of both the techniques were correlated by Kappa value which came out to be 0.923. There was very good agreement between SSG and HSG.

Conclusions: There was 92.3% agreement (KAPPA value = 0.923, Standard error = 0.437, 0.95 CI = 0.8373-1) between SSG and HSG which suggests that SSG is at least similar to HSG in its effectiveness for evaluating tubal patency and has the potential to replace HSG as routine, first-line outpatient infertility investigation.


Infertility, Hysterosalpingogram, Sonosalpingogram, Fallopian tubes

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Zegers-Hochschild F, Nygren KG, Adamson GD, de Mouzon J, Lancaster P, Mansour R et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009. Hum Rep. 2009;24(11):2683-7.

World Health Organization. Fertility and infertility. India; WHO;2014. Sexual and reproductive health; Infertility definitions and terminology; 2014. Available from:

Rastogi R. Role of imaging in female infertility. Indian J Radiol Imaging]. 2010;20(3):168-73.

Lall SS, Ghosh D, Saha D, Bhattacharya AR, Ghosh S, Mitra S. Comparative evaluation of sonosalpingography hysterosalpingography, and laparoscopy for determination of tubal patency. J ObstetGynecol India. 2007;57(2):158-61.

Sambharam K, Rode S, Bhalerao A. Comparison of sonosalphingography and laparoscopy in evaluation of tubal patency in infertility patients. International Journal of Scientific and Research Publications. 2015;5(7):1-5.

Padubidri VG, Daftary SN. Howkins and Bourne Shaw’s textbook of Gynaecology 15th edition. India: Elsevier; 2011. 210p.

Khalaf Y. Tubal subfertility. BMJ. 2003;327(7415):610-3.

Pandit SP, Adhikari BB, Pandit S. Comparison of sono-salpingography and X-ray hysterosalpingography in the sub-fertile women. PMJN. 2011;11(1):9-11.

Simpson WL, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. RadioGraphics. 2006;26(2):419-31.

Nor HM, Jayapragasam KJ, Abdullah BJJ. Diagnostic image quality of hysterosalpingography: ionic versus non-ionic water soluble iodinated contrast media. Biomed Imaging Interv J. 2009;5(3):e29.

Verhoeve HR. Diagnostic tests for tubal pathology from a clinical and economic perspective. The University of Amsterdam (UvA); 2013. Available from :

Panchal S, Nagori C. Imaging techniques for assessment of tubal status. J Hum Reprod Sci. 2014;7(1):2-12.

Lacroix SM, Boutin A, Moore L, Burgeron ME, Bujold E, Laberge P, et al. Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review with meta-analysis. Hum Reprod. 2014;29(5):953-63.

Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Battista Nardelli G. Side effects and complications of sonohysterosalpingography. Fertil Steril. 2003;80:620.

Lim CP, Hazafa Z, Bhattacharya S, Maheshwari A. Should a hysterosalpingogram be a first-line investigation to diagnose female tubal subfertility in the modern subfertility workup? Hum Reprod. 2011;26(5):967-71.

Rai PVS, Rao P, Reddy H. Hysterosalpingography (hsg) - the ‘last man standing’ among the erstwhile plethora of conventional radiological investigations. ‘how we do it’ and review of literature. International journal of medical and applied sciences. 2014;3(4):223-33.

Hajishafiha M, Zobairi T, Zanjani VR, Ghasemi-Rad M, Yekta Z, Mladkova N.Diagnostic value of sonohysterography in the determination of fallopian tube patency as an initial step of routine infertility assessment. J Ultrasound Med. 2009;28(12):1671-7.

Oguntoyinbo AE, Amok AOD and KomolafeOF. Sonographic assessment of fallopian tube patency in the investigation of female infertility in Ilorin, Nigeria. Afr J Reprod Health. 2001;5(1):100-5.

Tüfekçi EC, Girit S, Bayirli E, Durmuşoğlu F, Yalti S. Evaluation of tubal patency by trans-vaginal sonosalpingography. Fertile Sterile. 1992;57(2);336-40.

Suttipichate J, Sroywattana C, Dejthevaporn T, Virojchaiwong P, Sripramote M. Transvaginal saline sonosalpingography for the assessment of tubal patency. Thai J ObstetGynaecol. 2002;14(3):223-9.

Case AM, Pierson RA. Clinical use of sonohysterography in the evaluation of infertility. J ObstetGynaecol Can. 2003;25(8):641-8.

Mona Z, Radu V, Cristian A. Infertility investigation through saline infusion sonohysterosalpingography. Mædica A Journal of Clinical Medicine. 2007;2(1):10-7.

Goynumer G, Yetim G, Gokcen O, Karaaslan I, Wetherilt L, Durukan B. Hysterosalpingography, laparoscopy or both in the diagnosis of tubal disease in infertility. World Journal of Laparoscopic Surgery. 2008;1(2):23-6. Egypt and Kuwait: El-Tabbakh MN and Slamka P; 2011 Jul 05. Transvaginal sonohysterography (Tv-Sh),Versus hysterosalpingography (Hsg) And laparoscopy. Available from: laparoscopy/content/article/1760982/1896801#

Malik B, Patil S, Boricha BG, Kurkal N, Chaoudhry M. A comparative study of the efficacy of sonosalpingography and hysterosalpingogram to test the tubal patency in all women with primary and secondary infertility. Ultrasound Q. 2014;30(2):139-43.