The Sion Test

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Abstract
EDITORIAL COMMENT: There is no doubt that vaginal ultrasonography is a goer. An editorial opinion is that abdominal ultrasound investigation is used excessively, especially by general practitioners and nongynaecologists, but that vaginal ultrasound is yet to find its deserved place in gynaecology. Vaginal ultrasound certainly results in diagnoses of clinically significant lesions of the ovary missed by bimanual palpation (small cystic teratomas, tuboovarian abscesses and endometriotic haematomas). It is also of value when clinical findings are in doubt, or when the woman has postmenopausal bleeding and curettage is negative (a fundal polyp or cancer can be missed), since ultrasonography of the endometrium and uterine wall can give useful information. This paper explores the use of ultrasonography in women with infertility ‐ it is written with enthusiasm that kindles interest. It may well be that vaginal examination in gynaecological practice will ultimately be by gloved hand with vaginal probe in every case. It is all a matter of cost, convenience and complications. The ‘Sion test’ done in the rooms must surely risk ascending infection, and it is noted that the authors administer prophylactic antibiotic therapy for all patients undergoing this investigation. Our reviewer was uncertain of the possible value of the Sion test compared with the usual infertility investigations. It could be a useful screening test to identify those requiring hysterosalpingography and/or laparoscopy. These latter 2 tests are however often therapeutic as well as diagnostic and thus the Sion test may need to trial various ‘contrast’ media to evaluate the possibility of a therapeutic effect. A recent paper from the Methodist Hospital of Indiana (A) indicates that a similar ultrasonographic technique for investigation of women with infertility is also being evaluated in the United States of America. The discussion published with this paper indicates that the enthusiasm for vaginal ultrasonography expressed by our authors from Bombay is shared by their American colleagues, who also favour this ‘easier, cheaper and more convenient method for assessing the anatomy of the upper female genital tract in the evaluation of the infertile couple’.A. Peters AJ, Coulam CB. Hysterosalpingography with colour Doppler ultrasonography. Am J Obstet Gynecol 1991; 164: 1530–1534.Summary Endosonography as a tool for checking the patency of Fallopian tubes was an expected development in the progress the field of gynaecology was taking. We at Sion Hospital have used transvaginal sonography in evaluating the patency of Fallopian tubes with a technique which encompasses a thorough pelvic scan as well. We offer The Sion Test not as a substitute for hysterosalpingography, laparoscopy or hysteroscopy but as a screening technique in infertility investigation. The Sion Test can be performed in the gynaecologists' office at the same time as the pelvic examination. A series of 50 infertile patients had a diagnostic laparoscopy and hysterosalpingography after our test was done. We have compared the accuracy of the 3 methods of evaluating tubal patency and have found our test an excellent screening technique for investigations in infertility.

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