Hysterosalpingo-Foam Sonography to Replace HSG in Evaluating Tubal Patency in Indonesian Subfertile Patients

Abstract

Aim: To evaluate whether hysterosalpingo-foam sonography (HyFoSy) can replace HSG as first-line evaluation for tubal patency in subfertile Indonesian patients by evaluating agreement level and comparing patients' subjective complaints. Methods: Twenty subfertile female patients at Cipto Mangunkusumo Central General Referral Hospital (RSCM) from January 2018 to January 2019 were recruited conveniently to undergo both HSG and subsequent two-dimensional transvaginal HyFoSy after a minimum interval of 48 hours. Data on tubal patency and side effects inflicted by each examination within 24 hours were collected. Results: There were 20 subjects enrolled in this study. In 2 subjects, stenosis of internal uterine ostium was identified on HyFoSy procedure. Out of 36 remaining tubes undergoing adequate tubal patency evaluation by HSG and HyFoSy, agreement was seen in 81% cases (kappa value 0.42). The discordant tubal evaluation results in 7 of 36 tubes were associated with partial tubal obstruction, presence of co-existing gynaecological pathology, and tubal spasm. Less pain (p < 0.001) was experienced in HyFoSy as compared to HSG, with mean VAS of 1.8 ± 1.4 cm and 5.4 ± 2.4 cm, respectively. Seven of 20 patients experienced side effects due to HSG, such as abdominal cramp, spotting, backache, and bloating, in contrast to only one subject experiencing spotting due to HyFoSy. There was no hypersensitivity reaction observed in all subjects during HSG and HyFoSy procedure. Conclusions: HyFoSy has shown an excellent acceptance in Indonesian patients and could be a good alternative to replace HSG as a first line tubal patency examination.