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Objective: Our purpose was to compare hysterosalpingography with laparoscopy in the diagnosis of peritubal adhesions and to verify whether a combination of radiographic signs improves hysterosalpingographic accuracy., Subjects and Methods: Thirty candidates for laparoscopy underwent hysterosalpingography before surgery. Two radiologists evaluated the presence or absence and types of radiographic signs of peritubal adhesions (convoluted tubes, vertical tubes, loculation of contrast medium in peritoneum, halo effect, and fixed laterodeviation of the uterus) using two different criteria for normality or abnormality: no sign means a normal result, one or more signs mean an abnormal result (first criterion); no sign or one sign means a normal result, two or more signs mean an abnormal result (second criterion). Interpretation discrepancies were resolved by consensus. Peritubal and periovarian adhesions were evaluated by a single operating surgeon during laparoscopy (recorded on S-VHS videotape) and by a different surgeon reviewing the videotape. The radiographic results obtained using the two criteria in radiologically patent as well as in distally nonpatent tubes were compared with corresponding laparoscopic results by 2 x 2 tables and were statistically analyzed (kappa statistics)., Results: The first criterion displayed poor diagnostic accuracy. The correlation with laparoscopy was not statistically significant in either radiologically patent or distally nonpatent tubes. The second criterion greatly improved the agreement with laparoscopy, but only in patent tubes (kappa = 0.7789; p<0.001)., Conclusion: Hysterosalpingographic accuracy in peritubal adhesion diagnosis can be improved in patent tubes by taking into account more than one of the reported radiographic signs.

Since it serves as the site for the implantation of the fertilized ovum, it is evident that significant disorders in the uterine cavity and endometrial mucosa represent potential factors of sterility/infertility. Among the acquired pathological conditions, a possible cause of sterility, there are inflammatory (endometritis) or post-traumatic (synechiae) disorders and proliferative mucosal (endometrial hyperplasia, polyps) and muscular (fibroma) disorders. Sonography (by transabdominal or preferably endovaginal route, and sonohysterography) is the first choice procedure being in most cases adequate for clinical assessment. According to the specific disease, the diagnostic combination with hysteroscopy, hysterosalpingography, Magnetic Resonance Imaging can be suitable.

The diseases of the ovary which most frequently cause infertility are: anovulation from follicular atresia, the empty follicle syndrome, the luteinized unruptured follicle syndrome; chronic anovulation syndromes, within which polycystic ovarian syndrome plays a major role; ovarian endometriosis. Sonography and Color Doppler US are the first choice procedures in the monitoring of ovarian cycles, which combined with serum hormone values, are able to identify possible changes in the physiologic sequence of the cycle. In follicular atresia, ovaries with minute follicles (3mm or less) and early disappearance of primary follicle are observed on sonography. The empty follicle syndrome characterized by the lack of oocytes within the primary follicle, is of difficult sonographic diagnosis, a possible sign being the missed visualization of cumulus oophorus. The luteinized unruptured follicle syndrome consists in the absence of oocyte expulsion from primary follicle persisting more than 48 hours after LH blood peak. Doppler spectra of blood flow in perifollicular ovarian arteries maintain the features of the follicular phase, i.e. low diastolic velocities and high resistances. Among chronic anovulation syndromes, hyper-and hypogonadotropism cause ovarian amenorrhea where ovaries are similar to those of women in menopause: small size, very few or absent follicles. The polycystic ovarian syndrome is characterized by an abnormal pulsatile GnRH release which causes LH hypersecretion and FSH hyposecretion. The latter is not able to stimulate the growth and maturation of follicles, while the former causes hyperandrogenism with hirsutism and obesity and is responsible for hypertrophy and stromal hyperechogenicity. The sonographic diagnosis of polycystic ovarian syndrome is based on standardized morphostructural signs as increased volume of the ovaries (> 10 cm3), the presence of numerous (> or = 10) peripheral microfollicles (< or = 5 mm) with hyperechoic stroma. The endometrial cyst, usually present in ovarian endometriosis is visualized with sonography as a round neoformation with ill-defined walls, filled with a uniformly hypoechoic, corpuscular, partly hemorrhagic fluid; less frequently the appearance is that of a more complex structure posing differential diagnostic problems, mainly with the hemorrhagic corpus luteum; both pathological conditions appear poorly vascularized at Color Doppler, with tracings of high resistance arterial flow. Among the procedures of second choice, CT can show the high blood density common to the two conditions while on MRI the signal is mostly hyperintense in T1-weighted sequences with areas of lower signal intensity in T2-weighted sequences.