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Upper genital-tract screening with hysterosonography in patients receiving donated oocytes
1Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Objective:
To compare the results of sonohysterography (SHG) for imaging of the uterine cavity to hysterosalpingogram (HSG) and hysterscopy (HSC) in order to assess its clinical utility for recipients of donated oocyte.
Method:
From January 1996 to December 1996, we evaluated all patients (n = 50) referred for ovum donation using SHG and compared the results with HSG obtained within 6 months of SHG. Patients having either an abnormal SHG of HSG underwent HSC for confirmation and treatment. SHG was routinely performed during the early follicular phase using 10 cc saline instilled through an intracervical H-S catheter with concurrent vaginal sonography.
Result:
Pathology was observed and confirmed in 19 cases (38%) including polyps (n = 10, 52.6%), submucosal myomas (n = 7, 36.8%), intrauterine adhesions (n = 1, 5.3%) and bicornuate uterus (n = 1, 5.3%). SHG and HSG were concordant in 46 cases (95.8%) of which in 29 (60.4%) a normal cavity was observed, while four studies (8%) did not agree. Two polyps were missed on HSG, while two SHGs incorrectly diagnosed a calcified myoma and an endometrial fold. Using HSC for definitive identification, the accuracy of SHG was 90%, and similar to HSG.
Conclusion:
SHG appears both sensitive and highly predictive for evaluating pathology of the endometrial cavity and appears to be as effective as HSG. Advantages of SHG include improved imaging or uterine pathology, cost, greater patient comfort and the avoidance of radiation. Routine SHG of recipients uncovered a high incidence of abnormalities in older women and underscores the need to evaluate the uterine cavity prior to ovum donation.