Abstract
Objective This prospective study aimed to investigate the use of real-time three-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy), using contrast agent SonoVue, with B mode hysterosalpingo-contrast sonography (B mode-HyCoSy), to evaluate tubal patency and the wall of the Fallopian tubes in infertility patients. Method In total, we recruited 739 women with fertility requirements from the First Affiliated Hospital of Shantou Medical College between January 2017 and July 2018. All cases received 4D-HyCoSy using contrast agent SonoVue, immediately followed by the B mode-HyCoSy. Of these patients, 145 showed pathological findings in the Fallopian tubes during HyCoSy; 34 of these (62 Fallopian tubes) were verified by laparoscopy and the dye test against routine reference standards. Sonographic findings, along with laparoscopic findings and dye test results, were used to compare the two techniques using the Cohen kappa coefficient. We also investigated the duration of examination and pain score. Results Compared with laparoscopy and the dye test, the tubal occlusion diagnostic accordance rates for 4D-HyCoSy were 88.7% (32+23)/62, with a kappa coefficient of 0.769 and a 76.9% agreement rate. Distal occlusion diagnostic accordance rates for 4D-HyCoSy were 100% (8/8) with a k coefficient of 1.000 and a 100% agreement rate. Conclusions The use of 4D-HyCoSy, with B mode-HyCoSy, for the diagnosis of tubal patency is safe, feasible, noninvasive, and highly accurate. B mode-HyCoSy allowed us to observe tubal walls in an intuitive manner.
Highlights
While there are many reasons underlying infertility, tubal factors remaining are known as a significant cause of female infertility
All tests were performed with SonoVue successfully [739 of 739 (100%)]
We defined the segment which was more than 3 cm distal from the uterus as the distal part of the Fallopian tube [20]
Summary
While there are many reasons underlying infertility, tubal factors remaining are known as a significant cause of female infertility. Obstruction of the Fallopian tubes is responsible for infertility in at least 30% of female cases [1]. The techniques used to evaluate tubal patency include hydrotubation, X-ray hysterosalpingography (HSG), laparoscopy, and the dye test. Laparoscopy and the dye test are widely regarded as the current gold standard because of its intuitive approach and high accuracy. This technique is expensive, invasive, and associated with anesthetic and surgical risks [4]
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