Evaluation of fallopian tubes forms an essential part of evaluation Tubal pathology is a cause of infertility in 30- 35% of infertile patients Tubal Assessment Fallopian tubes can be assessed by: Hysterosalpingography Hysterosalpingo-contrast-sonography (HycoSy) Sonosalpingography Laparoscopy & CHROMOTUBATION

1. SonosalpingographySonosalpingography
Dr JYOTI AGARWALDr JYOTI AGARWAL
Dr. sharda jainDr. sharda jain

2. Evaluation of fallopian tubes forms
an essential part of evaluation
Tubal pathology is a cause of
infertility in 30- 35% of infertile
patients

3. Tubal Assessment
Fallopian tubes can be assessed
by:
1. Hysterosalpingography
2. Hysterosalpingo-contrast-
sonography (HycoSy)
3.3. SonosalpingographySonosalpingography
4. Laparoscopy &
CHROMOTUBATION

4. SONO-HYSTERO
SALPINGO-GRAPHY
• It is a procedure for testing tubal
patency similar to HSG HyCoSy
done under transvaginal ultrasound
guidance using sterile saline.
It can also be used to investigate
endometrial and the endometrial
cavity.

5. Indications
• Infertility
• Prior to assisted conception
• Abnormal uterine bleeding.
• Recurrent pregnancy loss to assess the
cavity.
• Amenorrhea or oligomenorrhoea

6. CONTRAINDICATIONS
Infection
Pregnancy

7. The normal and healthy fallopianThe normal and healthy fallopian
tubes are usually not seen bytubes are usually not seen by
transvaginal sonography unlesstransvaginal sonography unless
they contain fluid within theirthey contain fluid within their
lumen or are surrounded by fluid.lumen or are surrounded by fluid.
Tubes not visualized because :Tubes not visualized because :
1.Small diameter < 4 mm
2.Serpinginous course

8. SONOSALPINGOGRAPHY
(SION TEST)
Sonosalpingography (SSG) uses
transvaginal sonography to confirm tubal
patency by visualizing turbulence near
the fimbrial end when a mixture of air and
saline is injected through a Foley’s catheter
placed within the uterus.

9. Concept of SSG

10. Sonosalpingography
Negative contrast
Sonosalpingography
( Saline & Air mixture )
Positive contrast
Sonosalpingography
( Echovist )

11. ‘Sion test’
using sterile saline solution as a
negative contrast medium alongwith
with transvaginal ultrasound one canone can
evaluate the tubal patency, image theevaluate the tubal patency, image the
uterine cavity and assess the pelvisuterine cavity and assess the pelvis

12. Instrumentation

13. Procedure
Post menstrual
Informed consent
Premedication (30 minutes prior to
procedure)
. Inj.Diclofenac 1 amp x i.m.
Or
. Inj.Buscopan 1 amp x i.m.

14. Timing:
Best done is the
proliferative phase.

15. Preparation
onlypreparation
necessary for the
patient is to empty the
bladder.

16. sonohysterography, allows
identification of intracavitary
lesions and helps determine
whetheran abnormality is
endometrial or subendometrial.

17. The Thickened endometrium may be a
polyp
catheter

18. broad-based, hypoechoic,
With myomas the endometrial-
myometrial interface is distorted
The Thickened endometrium
may be a Submucosal leiomyomas

19. BenefitsBenefits
Office procedure
Low technology / Low cost
Better resolution
Better tolerability
No radiation exposure
Each tube can be assessed separately
Provides an accurate and more complete
assessment of uterine anatomy

20. LimitationsLimitations
Site of the tubal block not identified
Intra tubal mucosal pathology not
identified
Mobility of tube not assessed
There is risk of infection and pain.

21. Adverse Events
Pain & cramps in lower abdomen – 20%
Severe pain – 4%
Refered shoulder pain
Bleeding 3 %
Infection – 0 -1%

22. 85100502000Dijkhuizen
85100391998Williams
91871041998Schwarzler
76991091997Bernard
100100341997Keltz
10096471996Wolman
100961301995Widrich
94100581993Parsons
100100141993Syrop
9796961992Bonilla-Musoles
Specificity %Sensitivity %nYearAuthor

23. HSGHSG SSGSSG
Sensitivity Specificity Sensitivity Specificity
Randolf et al
(1986) 97 93 99 95
Sharma R.P.
(1989) ------------------- 98 96
Tufekci et al
(1992) ------------------- 90 96
Allahabadia et al
(1992) 88 80 98 91

24. USP
of SonosalpingographySonosalpingography
• The accuracy of saline SSG is comparable to
office hysteroscopy in detecting polyps,
fibroids and focal endometrial thickening. It is
better than HCG and transvaginal sonography
in detecting abnormalities of uterine cavity
and cause less pain than hysteroscopy and
concurrent assessment of uterine cavity and
tubal patency is possible a now it is to foured
in all infertility guidelines.

25. Sensitivity Specificity
SSG 98% 94%
Our Experience
5000 plus cases
We are very happy with test

26. CONCLUSION
Sonosalpingography (Sion test) is
an inexpensive , noninvasive ,
simple screening test that can be
done in the gynecologist's office at
the same time with endometrial
sampling in infertility evaluation.
Our experience of 5000 plus cases
speaks volume about it.

27. Sonohysterosalpingography
• It is a procedure for testing tubal
patency similar to HSG HyCoSy
done under transvaginal ultrasound
guidance using sterile saline.
It can also be used to investigate
endometrial and the endometrial
cavity.

28. ISO 14001:2004 (EMS)
…..Caring hearts, healing
hands
ISO 9001:2008
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