Assessment Of Tubal Patency Research Articles

The Role of Hysteroscopy in the Assessment of Fallopian Tubal Patency: A Comprehensive Review and Meta-analysis.

Hysteroscopy has been recognized as a reliable method for the evaluation of female infertility for several years. The outpatient setting is particularly convenient, as patients do not require general anesthesia and do not have to stay overnight. In recent years, more and more articles have dealt with the role of diagnostic hysteroscopy in tubal evaluation. Twenty-four articles were included in this comprehensive review and 14 of them were also included in a meta-analysis. This review provides an overview of the different techniques of hysteroscopic tubal evaluation, with a focus on perioperative changes in cul-de-sac volume, the air bubble technique ("Parryscope" technique), the Flow technique and selective hysteroscopic pertubation with methylene blue dye (SHPMBD). In pooled analyses, SHPMBD achieved the highest sensitivity for tubal patency (91.7%, 95% confidence interval, CI: 88.8-94.0), whereas the air bubble technique revealed the highest specificity of all methods (98.4, 95% CI: 95.3-99.6). Furthermore, in a meta-analysis of all methods on the assessment of single tubes, an overall sensitivity of 87.1% and an overall specificity of 79.8% (95% CI: 76.4-82.9) could be shown. In conclusion, the techniques of hysteroscopic tubal evaluation are well-tolerated, clinically relevant, and reliable.

Diagnostic accuracy of hysterosalpingo-foam sonography for assessment of fallopian tube patency in infertile women

Research questionWhat is the diagnostic accuracy of hysterosalpingo-foam sonography (HyFoSy), using two-dimensional ultrasound in tubal patency assessment in infertile women compared with laparoscopy with dye chromotubation? DesignThis prospective study was conducted at My Duc Hospital, Vietnam. Infertile women aged 18 years or older, who were scheduled for laparoscopy, were included. Visual Analogue Scale (VAS) score for perception of pain during HyFoSy was used. Laparoscopy was carried out on the same day. Clinicians undertaking laparoscopy were blinded to HyFoSy results. Sensitivity, specificity, negative and positive predictive value, and 95% confidence intervals were calculated. A sample size of 455 women (n = 910 fallopian tubes) was needed to demonstrate a fluctuation hypothesis, not exceeding 6%, for sensitivity and specificity (power 0.80, two-sided alpha 5%, loss to follow-up 5%). ResultsBetween 2019 and 2022, 455 participants were recruited. Hysterosalpingo-foam sonography was unsuccessfully carried out in six participants. Two withdrew their consent. Data analysis was conducted on the remaining 447 participants (n = 868 fallopian tubes). The sensitivity and specificity of hysterosalpingo-foam sonography compared with laparoscopy were 0.75 (95% CI 0.71 to 0.79) and 0.70 (95% CI 0.65 to 0.74), respectively. Hysterosalpingo-foam sonography gave a positive predictive value of 0.76 (95% CI 0.73 to 0.80) and negative predictive value of 0.68 (95% CI 0.64 to 0.73). A total of 42.8% of women reported a VAS score of no pain. No adverse event was reported. ConclusionCompared with laparoscopy with dye chromotubation, two-dimensional HyFoSy is a well-tolerated, reliable technique for assessing tubal patency.

Added Value of Contrast-enhanced US for Evaluation of Female Pelvic Disease.

Since the first application of contrast-enhanced US (CEUS) in the late 1960s, the use of US contrast agents has grown tremendously, and this examination has proved to be a valuable adjunct to diagnostic US for detection and characterization of disease. Also, CEUS has emerged as an excellent option for evaluation of indeterminate lesions that require additional imaging, given its excellent safety profile, including that in patients with end-stage renal disease or allergies to contrast material who are unable to undergo contrast-enhanced CT or MRI. US traditionally has been considered the imaging modality of choice for evaluation of the female pelvis, followed by MRI and rarely fluoroscopy, CT, PET, or angiography. CEUS has the potential to add significant value in imaging gynecologic disease, and indications for its use in the female pelvis are expected to continue evolving. It can aid in evaluation of nonvascular structures, such as assessment of tubal patency, uterine cavity morphology, and pelvic fistulas. CEUS can help characterize poorly vascularized gynecologic tumors or tissues with slow flow by using qualitative and quantitative parameters and aid in image-guided interventions or biopsies by facilitating visualization of lesions that are difficult to see with other imaging modalities. The authors provide an overview of current applications of US contrast agents in the female pelvis and discuss associated factors such as technique, interpretation, and image optimization. They also discuss the limitations of CEUS and describe its utility in the evaluation of female pelvic disease by using an organ system case-based approach. © RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Sequential-contingent strategy for fallopian tube evaluation using hysterosalpingo foam sonography: a cost analysis.

Tubal pathology is the etiological factor in 20% of couples with female infertility. Historically, diagnostic evaluation of the fallopian tubes has been performed by means of hysterosalpingography (HSG). Hysterosonosalpingography with EXEM® foam is a recent technique with supposedly comparable effectiveness to HSG, but with better tolerability for patients. Tubal patency was assessed in patients who were candidates for intrauterine insemination (IUI) between January 2020 and July 2021. (I) Hysterosonosalpingography with EXEM® foam. (II) If the patient had both tubes patent, IUI was proposed. In case of inconclusive or pathological results, HSG was performed. (III) If the HSG concludes tubal patency, IUI is proposed. On the other hand, if it results in tubal obstruction, in vitro fertilization (IVF) is proposed. Assessment of tubal patency by HSG showed concordance with previous Hysterosonosalpingography with EXEM® foam results in 45.5% (n=15) of cases of unilateral obstruction and 66.7% (n=6) of cases of bilateral obstruction. When we compare the total cost of HSG (€54,899.46) with the sum of patients who only required Hysterosonosalpingography with EXEM® foam together with those who underwent both tests (€45,575.96), it shows that the latter represents a cost benefit strategy (cost difference €9,323.50). Our results suggest a benefit of €9,323.50 when performing the contingent sequential strategy, in case of pathological or inconclusive results, compared to performing a systematic HSG in all patients. Patients with an obstructive hysterosalpingogram with EXEM® and a patent hysterosalpingogram will be the subgroup that will benefit the most, as IUI can be proposed instead of IVF. In addition, there is a benefit in terms of optimizing the medical procedure, hospital visits and speeding up the time to start assisted reproductive technology (ART).

#240 : Diagnostic Accuracy of Hysterosalpingo-Foam Sonography (HyFoSy) for Fallopian Tube Patency Assessment in Infertile Women

Background and Aims: Tubal patency assessment is an important part of routine infertility work-up. It has been suggested that hysterosalpingography should no longer be considered as a ‘first line’ diagnostic procedure. We aimto determine the accuracy of an alternative technique, hysterosalpingo-foam sonography (HyFoSy), in tubal patency assessment in infertile women. Methods: This prospective study was conducted at My Duc Hospital and was approved by the institutional ethics committee (25/2019/MD). Infertile women who were scheduled for undegoing laparoscopy during infertility investigation. A visual analogue scale (VAS) score for perception of pain during HyFoSy was used. Laparoscopywith dye chromotubation, was performed on the same day and used as a gold standard. Clinicians performing laparoscopy were blinded to HyFoSy results. Sensitivity, specificity, negative and positive predictive value (NPV, PPV)and 95% confidence interval (CI) were calculated. A sample size of 455 women was needed to demonstrate a non-exceeding 8% of fluctuation hypothesis of the two sensitivity and specificity (power 0.80, two-sided alpha 5%, loss to follow-up 5%). Results: Between 2019 and 2022, we recruited 455 women. Five women had inconclusive HyFoSy results, three women withdrew consents. Data analysis was performed on 447 women (868 tubes). The sensitivity and specificity of HyFoSy, as compared to laparoscopy, were 0.76 (95% CI 0.72–0.80) and 0.71 (95% CI 0.67–0.75), respectively. HyFoSy gave a PPV of 0.72 (95% CI 0.69–0.76) and a NPV of 0.75 (95% CI 0.72–0.78). 50% of women reported no pain. No adverse events were reported. Conclusion: HyFoSy is a well-tolerated, safe, and reliable technique compared to laparoscopy for tubal patency assessment.

EP32.03: Outcome of hysterosalpingo‐foam‐ultrasonography as an initial tubal patency assessment method in patients with subfertility

EP32.03: Outcome of hysterosalpingo‐foam‐ultrasonography as an initial tubal patency assessment method in patients with subfertility

O-271 Application of HyFoSy in the assessment of fallopian tube patency compared to HyCoSy and HS; results of a systematic review and meta-analysis

Abstract Study question To assess whether Hystero-salpingo-Foam Sonography (HyFoSy) is an effective and feasible alternative to X-ray Hystero-Salpingo-Graphy (HSG) and Hystero-salpingo-Contrast Sonography (HyCoSy) in fallopian tube patency assessment. Summary answer HyFoSy demonstrated significantly superior diagnostic sensitivity and specificity compared to HyCoSy, however only demonstrated minimal diagnostic agreement with HSG. What is known already Tubal pathology is a contributing factor in up to 35% of infertility cases, a fact which renders accurate and clinically applicable tubal patency assessment a vital component of the infertility workup. Currently, the most widely utilized methods of assessment are HyCoSy and HSG, which, while effective, do possess certain disadvantages. HyFoSy is an alternative to the aforementioned assessment test, utilizing a specially developed contrast agent, which may offer comparable diagnostic efficacy without the associated disadvantages of the other two methods. Study design, size, duration Relevant studies were systematically searched for in the Scopus, Pubmed and Web of Science online peer-reviewed databases. The resulting studies were systematically assessed based on pre-established inclusion criteria (PICOS format) according to the PRISMA algorithm for systematic reviews. The included studies were assessed for risk of bias using a modified version of the QUADAS-2 tool and relevant data was extracted and meta-analysis of diagnostic performance data was conducted. Participants/materials, setting, methods This analysis included data from 5 studies and 1433 patients, with 2336 tubes being eligible for inclusion. Data extracted regarding primary outcomes were true positive, false positive, false negative and true negative number of patients for studies that used a reference test and sensitivity and specificity could be calculated. For studies that assessed inter-method agreement, raw data on the number of patients with method agreement and disagreement was extracted and Cohen’s k values were calculated. Main results and the role of chance With regard to HyFoSy and HyCoSy comparison, pooled sensitivity was 87% and 69% respectively, with the difference being statistically significant (p = 0.037), while pooled specificity was 95% and 85% respectively, with the difference being statistically significant (p < 0.001). Regarding the HyFoSy and HSG comparison, the pooled Cohen’s k statistic resulting from the meta-analysis was 0.39 ; this is interpreted as fair to minimal overall diagnostic agreement between HyFoSy and HSG. Regarding procedure-associated patient pain, HSG was 6.5 times more painful (OR = 6.57, CI 95% 3.11–13.89) compared to HyFoSy and the former was graded at 5.4 ± 2.5 on a 10-point scale compared to the latter that was graded at 3.1 ± 2.2 (p < 0.001), a difference that was statistically significant. Limitations, reasons for caution The small number of available comparative studies on HyFoSy, the lack of studies that used a reference standard for the comparison of HyFoSy to HSG and the observed statistical heterogeneity, may have introduced a degree of bias in the results if this analysis. Wider implications of the findings HyFoSy, being less painful than HSG and more reliable in diagnosing patency, may be applicable as a first line diagnostic test, with HSG reserving its value in the evaluation of abnormal and/or unclear results as a second line test. Trial registration number not applicable

Diagnostic accuracy of pelvis multiparametric MRI against CT virtual hysterosalpingography: a prospective study of tubal patency through female infertility assessment.

To evaluate the diagnostic accuracy of MRI-hysterosalpingogram (HSG) with semiquantitative dynamic contrast-enhanced perfusion, against the virtual multislice CT hysterosalpingogram (VHSG) as a reference standard. In this prospective study, 26 women (age >18 years) searching for infertility causes and with VHSG physician request. Thereafter, the assessment performance of both techniques was determined by two reader analyses. k statistics were used for the assessment of tubal patency. Receiver operating characteristic (ROC) analysis was used to compare the capability for tubal patency assessment between both exams on a per-patient and per-tube basis. The McNemar test was used to compare the diagnostic accuracy measures. Tubal patency, uterine morphological, ovarian, and extrauterine abnormalities were evaluated through both exams in all 26 women. There was no significant difference between diagnostic performance measurements between the methods. The ROC curve of VHSG was 0.852 for both per-patient and per-tube analyses, and one and 0.938 for MRI-HSG. Sensitivity and specificity for per-patient and per-tube for VHSG were 95.2 and 97.7, 80 and 87.5%, and for MRI-HSG 100% for both analyses and 100 and 87.5%, respectively. This study demonstrates the feasibility of diagnosing tubal patency through MRI, using a semi-quantitative dynamic contrast-enhanced perfusion sequence, and the satisfactory diagnosing of the uterine morphology, ovarian abnormalities, and ovarian and deep endometriosis. Multiparametric MRI with a perfusion real-time sequence as a HSG method can be used in the evaluation not only for uterine and ovarian abnormilities but also tubal patency.

Diagnostic accuracy of hysterosalpingo-lidocaine-foam sonography combined with power Doppler (HyLiFoSy-PD) compared to laparoscopy and dye testing in tubal patency assessment in cases of infertility

BackgroundTubal patency testing is an essential part of female subfertility evaluation. Hysterosalpingogram is less invasive and less expensive compared to laparoscopy and dye testing (LDT), i.e., laparoscopic chromopertubation. Hysterosalpingo-foam sonography (HyFoSy) uses commercial echogenic gel foam that is easily visible on ultrasound to assess the tubes. It offers a safer and less painful alternative to HSG, with no radiation exposure. Hysterosalpingo-lidocaine-foam sonography with power Doppler (HyLiFoSy-PD) uses lidocaine-made gel foam as a contrast medium. It was postulated to as to be less painful and easier to detect on ultrasound, compared with hysterosalpingo-foam sonography using other contrast media and that it can also be used whenever the commercial gel used with HyFoSy is not available or is relatively expensive.MethodologyThis prospective diagnostic accuracy study was carried out between February 2018 and 2020 at the Cairo Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University. One hundred twenty-two infertile patients, who were already scheduled for LDT as a part of their infertility work-up, were consecutively recruited for this study. The HyLiFoSy-PD (index test) was performed 1 week before the scheduled LDT for these patients. Using an intrauterine pediatric Folley’s balloon catheter, 20 ml of lidocaine-made gel foam was slowly infused intrauterine, while observing their flow in both fallopian tubes using a grayscale and power Doppler transvaginal two-dimensional ultrasound system. All patients then underwent LDT (reference test). The results of HyLiFoSy-PD were compared with those of LDT to determine the accuracy of HyLiFoSy-PD in tubal patency assessment. We also assessed the procedure duration, associated pain, and other complications.ResultsComparing HyLiFoSy-PD with LDT in the 115 patients who completed the procedure, results showed 98.1% sensitivity, 90% specificity, 99% positive predictive value, 81.8% negative predictive value, 9.81 positive likelihood ratio, 0.02 negative likelihood ration, and 97.4% overall accuracy in the assessment of tubal patency (odds ratio = 463.5 with confidence interval = 79.39–2706; P-value: 0.687). The median procedure duration was 11 min. All patients experienced some degree of pain during the procedure with 91 patients (79%) reported mild pain and 24 patients (21%) reported moderate pain.ConclusionHyLiFoSy-PD was found to be an accurate tool in tubal patency assessment. It was also found to be safe and well-tolerated.

Evaluating the Effectiveness of Pharmacological Strategies and Further Measures for Pain Relief during Hysterosonosalpingography: A Systematic Review.

This systematic review aims to evaluate the effectiveness of pharmacological and non-pharmacological strategies for pain relief in women during contrast-enhanced ultrasound for the assessment of tubal patency and uterine disease, compared with placebo or no intervention. In December 2021, we searched the electronic databases (Pubmed, Embase, Sciencedirect, the Cochrane library and Clinicaltrials.gov) without date restriction: We identified 10 randomized control trials (RCTs) (2098 women) eligible for this systematic review, after applying our inclusion and exclusion criteria. Among these, five studies compared the use of painkillers with the placebo, two studies compared different catheter positions in the cervix or in the uterine cavity, and two others considered different temperatures of the contrast medium, as a method to reduce pain. Topical lidocaine applied before the procedure may be associated with effective pain relief during hysterosonography, though the quality of this evidence is low. New echogenic contrast agents and their temperature at 37 °C ensure a less painful procedure. There is insufficient evidence to draw conclusions on the efficacy of other analgesics or strategies.

Diagnostic role of magnetic resonance hysterosalpingography in the evaluation of female infertility

BackgroundIn the evaluation of female infertility, hysterosalpingography (HSG) with fluoroscopy provides limited evaluation of congenital uterine malformation and extrauterine disease. Transvaginal ultrasonography (TVS) is though commonly used, has its limitations in assessment of tubes. Addition of sonosalpingography can help assess tubal patency but may be inconclusive in cases of unilateral or bilateral obstruction and is grossly operator dependent. Recent past has seen evolution of magnetic resonance imaging (MRI) to evaluate problems associated with female infertility, with unparalleled advantages of having no radiation and being less operator-dependent. The need to assess tubal patency has been addressed by increasing literature on utilization of gadolinium (Gd) in MRI and comparing it with HSG alone or a mixture of HSG and laparoscopy. We aimed to evaluate the sensitivity and specificity of using magnetic resonance imaging (MRI) and magnetic resonance hysterosalpingography (MRHSG) as a screening test for female infertility and to compare accuracy, positive predictive value and efficacy of MRI and MRHSG with laparoscopy.ResultsFifty-four out of 63 patients had bilateral tubal patency (85.7%). Nine patients had tubal pathology (14.3%) out of which one had unilateral and eight had bilateral tubal obstruction. Endometrial cavity abnormality was found in four patients and ovarian abnormalities were detected in 28.5% patients. MRHSG has shown high sensitivity and specificity for tubal patency evaluation when compared to the true gold standard for tubal patency assessment, laparoscopic chromotubation. With laparoscopy as standard, there was 100% sensitivity and specificity for structural abnormality, myometrial abnormalities and endometrial cavity assessment in MRHSG.ConclusionsIn comparison with diagnostic laparoscopy, MRHSG was found to have good sensitivity and specificity for assessment of tubal patency, excellent sensitivity and specificity for the assessment of structural malformation and endometrial cavity lesions. Furthermore MRHSG was good in picking up extra-uterine diseases.

EP46.06: Implementation of hysterosalpingo‐foam‐sonography for the assessment of tubal patency

EP46.06: Implementation of hysterosalpingo‐foam‐sonography for the assessment of tubal patency

Are the Stage and the Incidental Finding of Endometriosis Associated with Fallopian Tube Occlusion? A Retrospective Cohort Study on Laparoscopic Chromopertubation in Infertile Women.

Endometriosis seems to have a strong negative effect on female fertility. The aim of this study was to assess the rate of tubal occlusion diagnosed via laparoscopic chromopertubation in infertile women with endometriosis and compare the results to infertile women without endometriosis. In this retrospective cohort study, 275 infertile women with endometriosis and 49 infertile women without endometriosis undergoing diagnostic laparoscopy for primary or secondary infertility with chromopertubation at the Medical University of Vienna between January 2012 and December 2020 have been investigated. During the laparoscopic assessment of tubal patency, significantly more fallopian tubes were occluded in the endometriosis group compared to the control group (25.8 versus 15.3%; p = 0.029). Unilateral and bilateral occlusion was found significantly more often in patients with endometriosis (p = 0.021). In the multivariate analysis, only the rASRM stage (the revised classification of endometriosis by the American Society for Reproductive Medicine) showed a significant association with bilateral occlusion (OR 1.400, 95%CI: 1.018–1.926; p = 0.038). Both a higher rASRM stage (OR 2.181, 95%CI: 1.191–3.995; p = 0.012) and secondary infertility (OR 1.514, 95%CI: 1.156–1.983; p = 0.003) were associated with an increased risk for any kind of fallopian tube occlusion. Endometriosis seems to be associated with an increased risk for fallopian tube occlusion. The rate of tubal occlusion increased significantly with the rASRM stage.

VNOTES for Ovarian Drilling: A New Minimal Invasive Technique

To show a new mini-invasive surgical technique of ovarian drilling and fertility workup using transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Stepwise demonstration of the technique with narrated video footage. Ovarian drilling is a surgical technique for patients with dysovulatory polycystic ovary syndrome. The aim of this technique is to destroy 5% to 10% of the ovarian cortex to restore spontaneous ovulation. Drilling is proposed as a second-line treatment in case of failure of treatments with clomid, metformin, or letrozole. The Cochrane 2020 review shows that drilling has the same pregnancy rate as the other second-line treatment: stimulation with gonadotropins [1]. After ovarian drilling, the results show 80% of spontaneous ovulation within 3 months and 50% of spontaneous pregnancy within a year; these results are effective in the long term [2]. The techniques used until now were either classic laparoscopy or transvaginal hydrolaparoscopy, which is currently not feasible owing to the cessation of the kit [3,4]. We present to you a new surgical technique: ovarian drilling by vNOTES. This new technique is minimally invasive, without scarring on the abdomen, and very well tolerated. It allows simultaneous ovarian drilling and fertility workup with assessment of tubal patency and uterine cavity by hysteroscopy. It is recommended to use bipolar energy to reduce ovarian lesions and limit the risk of adhesion [5]. Transvaginal laparoscopic ovarian drilling is a minimally invasive surgical technique using a vNOTES kit from Applied Medical (Rancho Santa Margarita, CA), a hysteroscope of 5 mm with an operating channel from Delmont Imaging (La Ciotat, France), and a bipolar spring electrode, Versapoint from Olympus (Hamburg, Germany). The key steps to perform this surgery are as follows: 1. Perform a diagnostic hysteroscopy with vaginoscopy 2. Perform a posterior colpotomy 3. Introduce the Alexis retractor into the Douglas and place the GelPOINT with 2 sleeves 4. Introduce the hysteroscope into the pelvic cavity with serum saline, using a pressure of approximately 150 mm Hg 5. Drill approximately 10 holes on each ovary using the bipolar electrode 6. Explore the pelvic cavity with the possibility of performing a blue test for tubal patency 7. Suture the posterior vagina CONCLUSION: Ovarian drilling is a surgical treatment proposed after the failure of first-line treatments in polycystic ovary syndrome to obtain long-term spontaneous ovulations. The development of minimally invasive techniques such as vNOTES will highlight this treatment and allow it to be performed easily and with minimal adverse effects on patients, especially in bariatric women for whom the vNOTES technique provides easier access to their pelvic cavity than abdominal laparoscopy.

Is Hysterosalpingo-Contrast Sonography (HyCoSy) Using Sulfur Hexafluoride Microbubbles (SonoVue) Sufficient for the Assessment of Fallopian Tube Patency? A Systematic Review and Meta-Analysis.

This study aimed to evaluate the diagnostic value of HyCoSy using sulfur hexafluoride microbubbles for fallopian tubal patency assessment in infertile females. Twenty-four studies, including 1358 females with 2661 detected fallopian tubes published from January 2003 to May 2019, were identified. The pooled sensitivity was 93% (95% CI: 90-95%), while the specificity was 90% (95% CI: 87-92%). The area under the receiver-operating characteristic curve was 0.96 (95% CI: 94-98%). The specificity of the four-dimensional HyCoSy subgroup was higher than the 2D/3D subgroup; an increased dose of contrast agent did not affect the specificity, with only a slightly reduced sensitivity.

Factors associated with non-visualisation of tubal patency during Hysterosalpingo-Foam-Sonography

ObjectiveInvestigate potential factors associated with non-visualisation of tubal patency during Hysterosalpingo-Foam-Sonography (HyFoSy). Study designThis retrospective study was carried out at the medically assisted procreation centre of the University Hospital Centre in Reunion Island and focuses on HyFoSy performed between 01/01/2018 and 31/12/2020.We aimed to compare HyFoSy with bilateral tubal patency and those with a passage defect. Factors associated with non-visualisation of the contrast medium were investigated using comparison tests and logistic regression. Explanatory variables were patient history and ultrasound characteristics. Results137 eligible HyFoSy were included, of which 70.8% could be established for bilateral tubal patency.The assessment of tubal patency decreased in cases of overweight/obesity (62.5% versus 47.4%), previous pelvic surgery (17.5% versus 10.3%) and deep endometriosis (12.5% versus 5.2%), without significant difference. In the logistic regression model, a trend towards significance was observed for body mass index ≥ 25 kg/m² (OR 2.01 [95% CI 0.93–4.35], p= 0.07). ConclusionHyFoSy as a first-line infertility test should be discussed in certain circumstances, due to risk of non-visualisation of tubal patency. In case of poor echogenicity, it should be performed by a trained ultrasonographer or a hysterosalpingography should be preferred. For tubo-pelvic pathologies, a laparoscopy should be discussed for diagnostic and therapeutic purposes. Disciplinegynaecology, infertility.

Hysterosalpingography for Diagnosing Tubal Patency in Infertile Women

Objective : Tubal obstruction is one of the most common causes of female infertility. While laparoscopy (LS) is the gold standart method for assessing the patency of the tubes, hysterosalpingography (HSG) is widely used as a first-line approach in infertility work-up. The aim of this study was to compare HSG and LS in assessment of tubal patency. Materials and Methods : Patients who underwent HSG, followed by LS for primary and secondary infertility between January 2015 and June 2017 were retrospectively analyzed. The laparoscopic findings were accepted as reference standard to calculate the diagnostic accuracy of HSG for tubal patency. Results : A total of 67 patients were included into the analysis. The sensitivity, specificity, positive and negative predictive values of HSG for bilateral tubal patency were 82%, 75%, 91% and 57%, respectively. The sensitivity, specificity, positive and negative predictive values of HSG for bilateral tubal obstruction were 62%, 93%, 55% and 94%, respectively. Conclusion : Our findings showed that HSG has high validity, on predicting tubal patency in particular. Laparoscopy should be used in patients with HSG showing nonpatency.

Spontaneous pregnancy rates in infertile women after sequential hydrosonography and hysterosalpingo-foam sonography

ObjectiveTo determine the clinical pregnancy rate following sequential hydrosonography and hysterosalpingo-foam sonography (HyFoSy) in tubal patency assessment among women undergoing infertility work-up. Study designProspective follow-up of women referred to our department between July 2019 and October 2020. Sequential hydrosonography and HyFoSy were carried out. ResultsOut of 250 having the procedure, 100 women were excluded from study due to limited infertility, semen abnormal or not examined, evaluation for social egg freezing or they were single. Of the remaining 150 women, 48 (32%) conceived during a 10–24 months follow-up period: 17 (11%) conceived naturally and 7 (4.7%) by IUI. The mean time to conception was 5.5 ± 5.4 months and the pregnancy rate was 52% within 6 months. Among the spontaneous pregnancies 47% occurred within a month and 76% within 3 months. ConclusionSequential hydrosonography and HyFoSy is a promising method for assessing the uterine cavity and tubal patency in women undergoing infertility workup. The findings suggest that the procedure may increase the chance of a spontaneous pregnancy following the procedure. Given the other known advantages of sequential hydrosonography and HyFoSy, this test is worth including in the initial workup for infertile patients.

4D-HyCoSy performed in a reproductive center: retrospective analysis of pain perception, complications and spontaneous pregnancy rate after the technique.

Nowadays 4D hysterosalpingocontrast sonography (4D-HyCoSy) represents a primary technique in the evaluation of tubal impairment, with a low rate of pain referred and complications related, but its role in increasing the chance of spontaneous clinical pregnancy in women in childbearing age is still debated. Retrospective study of 359 women performed 4D-HyCoSy at Reproductive Physiopathology and Andrology Unit, Sandro Pertini Hospital, Rome, during the period 2018-2020. women attending our IVF (in vitro fertilization) center with at least 1 year of infertility. female age over 43 years, previously known severe tubal infertility, suspected anovulation, and semen abnormalities. evaluation of tubal patency, complications related to technique, and pain perception evaluated thanks to a 10-cm visual analogue scale (VAS) Scale. clinical pregnancy rate (PR) after the technique confronted between the group of women with bilateral tubal patency (group A) with the group of monolateral tubal patency (group B) within 30 days and between 30-180 days, and 180 days-1 year from the exam. Time to pregnancy (TTP) and other obstetrical outcomes were evaluated too. The average age of the study's population was 33.3 years. Mean duration of infertility was 2.1 years. Complication rate was 6.4%, and in any case the use of ephedrine was required. 182 (50.6%) women reported absence of pain during the exam (VAS scale value 0) and 131 (36.5%), reported mild pain experience (VAS scale value between 1-4). Spontaneous pregnancy rate was of 29.3% in group A and 30.3% in group B; time to pregnancy was 32 ± 14.7 days in group A and 35 ± 13.1 days in group B. The insurgence of a spontaneous pregnancy was significantly lower for both 4D-HyCosy sub-groups after 30 days following technique respect to 30-180 days and 180 days-1 year following the technique (both p-value < 0.001). We confirm that 4D-HyCoSy is a safe and user-friendly technique, used as first line assessment of tubal patency of women afferent to a reproductive center. We also reported a positive impact on spontaneous pregnancy rate in women performing 4D-HyCoSy, emphasized within the first following month. This mandatory technique for tubal investigation, has not only a function in the diagnostic assessment of female infertility, but also has a therapeutic role, in young women who desire a pregnancy, avoiding, in some cases, the need of IVF treatments and clinical risks linked, while saving medical and monetary resources.

Tubal patency assessment using sequential transvaginal ultrasound and hysterosalpingo-foam sonography after methotrexate treatment for tubal pregnancy

Research questionWhat is the efficacy of sequential two-dimensional transvaginal ultrasound (2D-US) and hysterosalpingo-foam sonography (HyFoSy) after methotrexate (MTX) treatment for tubal pregnancy among patients who desire a future pregnancy? DesignA prospective trial conducted between May 2019 and November 2020. Patients who had a suspected tubal ectopic pregnancy diagnosed by ultrasound and treated by MTX were included. These patients underwent sequential transvaginal 2D-US assessment of the pelvic organs and a complementary HyFoSy for tubal patency. The primary outcome was tubal obstruction in the affected side. ResultsA total of 360 women underwent sequential transvaginal 2D-US assessment of the pelvic organs and a complementary HyFoSy for tubal patency. Of these, 40 (11.1%) women fulfilling the inclusion criteria were enrolled. In six out of 40 (15%), hydrosalpinx of the affected tube was found during the initial transvaginal ultrasound examination and were excluded from further investigation. In the remaining 34 (85%) patients, HyFoSy was carried out. Tubal block was found in 10 out of 34 (29.4%) patients. Of these, eight out of 34 (23.5%) and two out of 34 (5.9%) had a proximal block of the affected tube and bilateral proximal obstruction, respectively. Hysterosalpingography confirmed the tubal obstruction in all the affected cases. No procedure-related complications were documented. ConclusionsForty per cent of women who were treated by MTX for tubal pregnancy were diagnosed with tubal obstruction. We recommend that sequential transvaginal ultrasound and HyFoSy become part of routine follow-up for these women, thus offering them timely referral to the appropriate specialist.