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

Herbert Situmorang,Harry Prawiro Tantry,Eka Rusdianto Gunardi

doi:10.4236/ojog.2020.10100129

Herbert Situmorang, Harry Prawiro Tantry + Show 1 more

Open Access

https://doi.org/10.4236/ojog.2020.10100129

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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 ± 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.

Highlights

15% of couples suffered from subfertility, 40% of which were attributed to tubal factor in developing countries [1] [2] necessitating a feasible and well-tolerated tubal patency examination across the geographically scattered islands in Indonesia for easier and earlier access to subfertility treatment
hysterosalpingo-foam sonography (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
Tolerance study that was performed by Dreyer et al in 2015 in the Netherlands to compare the pain experienced during HyFoSy in comparison to HSG found a significantly lower pain score for HyFoSy with median Visual Analogue Scale (VAS) score of 2.0 cm compared to HSG with median VAS score of 5.1 cm [6]

Summary

Introduction

15% of couples suffered from subfertility, 40% of which were attributed to tubal factor in developing countries [1] [2] necessitating a feasible and well-tolerated tubal patency examination across the geographically scattered islands in Indonesia for easier and earlier access to subfertility treatment. An emerging non-invasive and bedside tubal patency examination with superior diagnostic value and patient’s satisfaction as compared to HSG, known as hysterosalpingo-foam sonography (HyFoSy), has been initiated in Indonesia at Ciptomangunkusumo Central General Referral Hospital (RSCM) since 2018. Zizolfi et al in Italy performed a concordance study between HyFoSy and HSG that was performed on 50 women who had undergone hysteroscopic Essure microinsert placement and found a concordance rate of 100% [5]. Another study by Dreyer et al in the Netherlands showed a 97.4% concordance between HyFoSy and HSG in evaluating tubal occlusion in 26 women undergoing Essure placement due to hydrosalpinx before in vitro fertilization [6]. HyFoSy offers an instant tubal patency result in an approximately 5-minute bedside procedure requiring only a two-dimensional (2D) transvaginal ultrasonography and the ExEm-foam kit consisting of hydroxyethylcellulose-glycerol gel and its cervical cannula. Tolerance study that was performed by Dreyer et al in 2015 in the Netherlands to compare the pain experienced during HyFoSy in comparison to HSG found a significantly lower pain score for HyFoSy with median VAS score of 2.0 cm compared to HSG with median VAS score of 5.1 cm [6]

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