Evaluation of the performance of hysterosalpingo contrast sonography in 500 consecutive, unselected, infertile women

Abstract

The performance of hysterosalpingo contrast sonography (Hy Co Sy) as a first-line, outpatient investigation of tubal patency was examined in 500 consecutive, infertile women, at one centre. Hy Co Sy was completed in 463 (92.6%) cases, using a galactose microbubble contrast agent (Echovist-200) and transvaginal sonography. Initial plain scanning identified adnexal pathology in 198 women (39.6%). Examination with Echovist was attempted for 905 tubes and only 67 (7.4%) were not assessable; after the first 100 women this decreased to 35 tubes (4.8%). A sonographic appearance compatible with blocked tubes was found on 118 (14.1%) occasions but it was also possible to identify variations in the appearance/filling/spilling patterns of individual tubes which increased the number assessed as abnormal to 193 (23.0%). Comparison with laparoscopy and dye chromopertubation findings from the past three years was possible for 185 (37%) women, representing 282 tubes, which gave Hy Co Sy an overall concordance rate of 85.8%, sensitivity of 90.4%, specificity of 70.3%, positive predictive value of 91.2% and negative predictive value of 68.2%. Some 51.0% of women described only mild discomfort and there were no significant postprocedure complications. Hy Co Sy appears to be an acceptable first-line screen and may select out women in whom more invasive investigations are likely to reveal pathology.

Pain and side effects associated with 4-dimensional hysterosalpingo-contrast sonography for evaluating of the fallopian tubes patency

“…Despite many patients reporting pain during the procedure, all of the patients reported satisfaction with the procedure. Prior articles documented that the mean times (12 to 13.9 minutes) and the contrast agent doses (5 to 15 ml) for 2 D HyCoSy [5,[20][21][22]. In our research, the longest whole assessment time attained 30 minutes, and the maximum SonoVue dosage arrived at 37 ml, primarily due to lack of experience in the beginning.…”

Current methods of tubal patency assessment

“…One of its limitations is the rapid degradation requiring the solution to be mixed immediately before infusion, as its ultrasonic hyperechoic characteristics are usually lost within 5 minutes. Given that Echovist-200 is not FDA approved in the United States, other providers have substituted a mixture of saline and air for the distending media (16,(40)(41)(42). Some studies reported vigorously shaking a syringe of saline and air immediately before infusion.…”

“…Some studies reported vigorously shaking a syringe of saline and air immediately before infusion. Alternatively, a syringe filled with both air and saline can be tilted such that an intermittent infusion of air is followed by saline in increments of 1-3 mL at a time (16,(40)(41)(42)(43). More recently, Femasys has achieved US FDA approval for the Femvue Sono Tubal Evaluation System, designed to simultaneously introduce air and saline in a controlled fashion.…”

“…Some of the associated side effects are procedural discomfort, post-procedure vaginal bleeding, vasovagal reaction, and referred shoulder pain (40,47,51). One study that evaluated patient tolerance of the HyCoSy procedure compared with conventional HSG was completed in the United Kingdom (47).…”

Evidence Based Diagnostic Approach to Tubal Factor Infertility

“…The tube can now be examined directly in real time under magnification and in its natural habitat under physiological conditions contrary to HSG. 22 Exploration of the tube is now more extensive with more dynamic investigative maneuvers and with less risks, incidents and accidents.…”