Diagnostic Accuracy Study Comparing Hysterosalpingo-Foam Sonography and Hysterosalpingography for Fallopian Tube Patency Assessment

Abstract

Introduction: Simplified ultrasound-based infertility protocols that appear to provide enough information to plan effective management have been described. Thus, the objective of this study is to compare the diagnostic accuracy of the hysterosalpingo-foam sonography (HyFoSy) in tubal patency testing with the traditional hysterosalpngography (HSG) for establishing a new diagnostic strategy in infertility. Material and Methods: Prospective observational diagnostic accuracy was performed in a private fertility clinic in which 106 women undergoing a preconceptionally visit were recruited. All of them had low risk for tubal disease, had performed an HSG and were negative for Chlamydia trachomatis antibody. Main outcome measures were tubal patency and pain grade. Results: Evaluation of tubal patency by HyFoSy showed a total concordance with the results of the previous HSG in 72.6% (n = 77), and a total discordance for 4.7% (n = 6), with the inter-test agreement Kappa equal to 0.57, which means moderate concordance. Among the patients, 59.1% did not report pain during the procedure, while the remaining 48.1% indicated pain in different degrees; patients usually report less pain and only 6.6% described more pain with HyFoSy than with HSG (OR 6.57 (CI 95% 3.11–13.89)). Clinical outcomes after performing HyFoSy were not affected. Conclusions: HyFoSy is in concordance with HSG regarding tubal patency results and it is a less painful technique than HSG. HyFoSy is more economical and can be performed in an exam room only equipped with an ultrasound scanner. Based on these results, HyFoSy could be the first-choice diagnostic option to assess tubal patency in patients with low risk of tubal disease.

Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Patency in Women with Infertility Taking Laparoscopy as Gold Standard

“…Analysis of the age distribution of 178 patients revealed that n=53 (or 30%) patients were between the ages of 18 and 25, n=98 (or 55%) patients were between the ages of 26 and 35, and n=27 (or 15%) patients were between the ages of 36 and 45. The standard deviation was 1.26, and the mean age was 27 years (as shown in table No A study conducted by Julia Ramos et al [5] in 2021, which compared the results of Hysterosalpingo-Foam Sonography and Hysterosalpingography in the assessment of tubal patency. A total concordance was seen in 72.6% of the cases while a total discordance in 4.7% of the cases.…”

“…The most common tubal disease responsible for sub fertility in women is PID. Other causes include endometriosis, pelvic tuberculosis, previous pelvic surgery and fibroids [5].The resultant tubal abnormities include obstruction, stenosis, dilatation and impaired peristalsis. Assessment of the site and extent of tubal disease is important as it will affect the treatment of the patients.…”

Hysterosalpingography is obsolete: hysterosalpingo-contrast foam sonography should be the alternative

“…This is probably due to the implementation of an appropriate learning curve. What is more, in the study of van Welie and collaborators, where the primary outcome for the comparison of the two strategies was ongoing pregnancy leading to live birth within 12 months after inclusion, the estimated live birth rate was 46% in the HyFoSy group versus 47% in the HSG group, confirming non-inferiority between the two techniques (Emanuel et al, 2012;Ramos et al, 2021;van Welie et al, 2022).…”

“…The multicentre study of Van Welie and colleagues, which included 1026 participants, pointed out that the average VAS pain score for HyFoSy was 3.1 whereas the mean VAS pain score for HSG was 5.4 (van Welie et al, 2022). Therefore HSG can result in an overdiagnosis of tubal occlusion possibly due to tubal spasms caused by pain during the procedure (Dreyer et al, 2014;Ramos et al, 2021).…”

Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Patency in Women with Infertility Taking Laparoscopy as the Gold Standard

“…The most common tubal disease responsible for sub fertility in women is PID. Other causes include endometriosis, pelvic tuberculosis, previous pelvic surgery and fibroids (5). The resultant tubal abnormities include obstruction, stenosis, dilatation, and impaired peristalsis.…”