The Comparison of Hysterosalpingography and Saline Infusion Sonography in Diagnosis of Uterine Cavity Disorders in Infertile Women Publisher



Lorzadeh N ; Jahanshahi M ; Hashemi S N
Source: Middle East Fertility Society Journal Published:2026

Abstract

Background: Among the different causes of infertility, uterine cavity malformations are one of the chief causes with a prevalence of 10–15% in infertile couples. The purpose of this study is to compare the diagnostic accuracy of hysterosalpingography (HSG) and saline infusion sonography (SIS) against the gold standard of hysteroscopy in infertile patients with suspected uterine malformations. Methods: In this prospective diagnostic accuracy study, 45 infertile females referred to Mirza Kouchak Khaan Hospital were evaluated. All participants underwent three diagnostic procedures: HSG, SIS and hysteroscopy. The diagnostic performance parameters (sensitivity, specificity, positive predictive value, and negative predictive value) of HSG and SIS were calculated and compared using hysteroscopy as the reference standard. Results: From hysteroscopy, 34 normal cases, 7 with polypoid disorders, 2 with intrauterine adhesions and 2 cases (4.4%) of suspected congenital anomalies (bicornuate/septate uterus) were identified. HSG showed 7 cases (15.6%) of misdiagnosis (sensitivity = 82%, specificity = 85%, Positive predictive value (PPV) = 64% and negative predictive value (NPV) = 94%), while from SIS, only one case of false negative result was seen (sensitivity = 89%, specificity = 100%, PPV = 100% and NPV = 97%). In this sample, the overall diagnostic accuracy was 84.4% for HSG and 97.8% for HDS, though these values are limited by the small number of total pathological cases and are accompanied by wide confidence intervals. Conclusion: Our preliminary findings suggest that SIS shows promising diagnostic alignment with hysteroscopy for intracavitary assessment within this small cohort. However, given our small sample size and limited pathological cases, these findings must be interpreted with caution. These data do not support a definitive claim of diagnostic superiority, and large-scale, fully powered multicenter prospective studies are strictly required to validate these preliminary observations. © The Author(s) 2026.