الفهرس 
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Abstract
Aim of the work to compare the diagnostic accuracy , acceptability, reliability and sensitivity of saline infusion sonohysterography (SIS) and hysteroscopy for evaluation of intracavitary abnormalities in woman with abnormal sonographic and hysterosalpigographic finding.Ultrasound imaging of the female reproductive tract was first described in 1972 by Kratochwil et al., (Kratochwil et al; 1972). and currently represents one of the most common procedures performed by gynaecologists. The recent advances in ultrasound technology have promoted transvaginal ultrasound (TVS) as a non-invasive, low-cost alternative to hysteroscopy. Indeed, it provides good visualisation of the endometrium, mid-line echo and uterine cavity. The simplicity of the ultrasound examination has led gynaecologists to consider TVS as the ‘first step’ procedure in the evaluation of the uterine cavity. However, which is the best method for the evaluation of the uterus is still a matter of debate. Indeed, a single technique that is 100% reliable, accurate, well-tolerated and low-cost is still to be identified. (Grandberg et al .,1991Saline infusion sonography (SIS) is a real-time imaging technique for visualization of the endometrium and endometrial cavity. Sterile saline installation into the endometrial cavity with the aid of the two-dimensional B-Mode transvaginal ultrasonography (TVS) is an easy, fast, cheap and well-tolerated technique for diagnosis of uterine cavity pathologies. SIS offers a detailed vision of the uterine cavity compared to the TVS and can prevent the patient from more invasive procedures such as diagnostic hysteroscopy. Additionally, SIS can also be used to evaluate the tubal patency in some instances (Fleischer et al; 1997) and to search for retained products of conception. (Wolman et al; 2000)Hysteroscopy has the advantage of directly visualizing the uterine cavity and endometrium, but it cannot comment on myometrial pathology. The choice of diagnostic procedure seems to be determined largely by clinician’s preference. However, acceptability of the procedure by subjects is very important. (Kelekci, et al; 2005)Aim of the work
To compare the diagnostic accuracy , acceptability , reliability and sensitivity of saline infusion sonohysterography (SIS) and hysteroscopy for evaluation of intracavitary abnormalities in women with abnormal sonographic and hysterosalpigographic findingsDay 1 of the menstrual cycle refers to the first day of menstruation. At this time oestrogen levels are low and follicle-stimulating hormone (FSH) is secreted by the pituitary gland and stimulates follicular development within the ovary. The granulosa cells of the growing follicles produce oestrogen, which acts upon both the hypothalamus (reducing gonadotrophin-releasing hormone production [GnRH]) and pituitary gland. Secretion of FSH from the pituitary is thus inhibited (negative feedback) and circulating FSH levels fall. Only the largest ‘lead’ follicle possesses enough FSH receptors to continue growth and oestrogen production, the other follicles becoming atretic (days 5–7). (Jeffcoate; 1992)This hormonal ‘surge’ triggers ovulation (day 14) and oestrogen levels fall temporarily so that positive feedback on the hypothalamus and pituitary ceases and is replaced by a negative feedback effect resulting in a fall in FSH and LH. The collapsed postovulatory follicle is transformed into a corpus luteum. The granulosa and theca cells of the newly formed corpus luteum produce oestrogen, and more importantly progesterone, so that a stable secretory endometrium is produced in anticipation of conception and ensuing embryonic implantation.
In the absence of pregnancy (trophoblast producing human chorionic gonadotrophin), the corpus luteum cannot be maintained and starts to wane after 7–10 days. Hormone production declines rapidly and it is this progesterone withdrawal that triggers menstruation 14 days