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

Julia Ramos,Nicolás Prados,Esther Santamaría-López,Francisco Carranza,Manuel Fernández-Sánchez,Cristina González-Ravina,Cinzia Caligara,Víctor Blasco

doi:10.3390/jcm10184169

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.

Highlights

Simplified ultrasound-based infertility protocols that appear to provide enough information to plan effective management have been described
The evaluation of tubal patency by hysterosalpingo-foam sonography (HyFoSy) showed a total concordance with the results of the previous HSG in 72.6% (n = 77) of the cases (Table 2)
We described a total discordance for 4.7% of the procedures (n = 5); 3.8% (n = 4) were diagnosed with a bilateral obstruction by HyFoSy while both of their tubes were patent according to HSG test, and 0.9% (n = 1) was diagnosed with unilateral patency, but in a different tube depending on the test performed

Summary

Introduction

Simplified ultrasound-based infertility protocols that appear to provide enough information to plan effective management have been described. 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. 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. The cornerstones of investigation for an infertile couple have been grouped into several testing categories, with the evaluation of uterine architecture and tubal patency being one of the most important ones [1]. Tubal disease encompasses a range of pathologies, with pelvic inflammatory disease (PID) as the most common cause; it is usually asymptomatic, and its main causal agent is Chlamydia trachoma-

Objectives

Methods

Results

Discussion

Conclusion