HyCoSy Research Articles

Saline-Air Hysterosalpingo-Contrast Sonography Is Equivalent to the Modified Hysterosalpingogram Following Hysteroscopic Sterilization.

To estimate the diagnostic efficacy of saline-air hysterosalpingo-contrast sonography (SA-HyCoSy) compared with the modified hysterosalpingogram (mHSG) for confirmation of both coil location and tubal occlusion following hysteroscopic sterilization. This study included 19 women who underwent both SA-HyCoSy and mHSG where 1 test was followed by the other. Sensitivity, specificity, and positive and negative predictive values for tubal occlusion against the mHSG were calculated for each fallopian tube by 2 independent interpreters. Interrater reliability was assessed using Cohen κ statistic. Procedure time and pain level by 11-point numeric rating scale of SA-HyCoSy and mHSG were also compared. Thirty-eight fallopian tubes were evaluated. Tubal occlusion was noted in 97.3% of tubes for both interpreters with the mHSG compared with 92.1% and 94.7% with SA-HyCoSy. The positive and negative predictive values for tubal occlusion were 100%/100% and 50%/33%, respectively, with an overall agreement of 97.4% and 95.7%, κ = 0.48, P < 0.01. Saline-air HyCoSy changed interpretation of coil insert location in 50% and 44.7% for each interpreter, being downgraded from optimal to satisfactory in 42.9% (9/21) and 36% (9/25) and upgraded to optimal in 58.8% (10/17) and 61.5% (8/13), respectively. There were no statistically significant differences in procedural time (7.5 vs 9.4 minutes, P > 0.05) or maximum pain scores (2.3 vs 3.1, P > 0.05) for the mHSG compared with SA-HyCoSy. Our findings revealed a high degree of diagnostic accuracy with SA-HyCoSy for tubal occlusion, although coil location changed in nearly half of cases. Avoidance of radiation and patient convenience/compliance with SA-HyCoSy may outweigh the drawbacks.

Lipiodol visibility under ultrasound.

Lipiodol is an oil-based solution commonly used in hysterosalpingogram (HSG), but not hysterosalpingo contrast sonography (HyCoSy). In women with unexplained infertility, evidence suggests that tubal flushing with Lipiodol results in improved fertility post-procedure. We propose that Lipiodol can be visualised under ultrasound similar to commonly used saline, and hence utilised for HyCoSy, allowing the benefit of an oil-based tubal flushing to occur with HyCoSy. To examine whether Lipiodol is visible sonographically, assess optimal agitated Lipiodol mix and ultrasound settings for visibility, and compare visibility to agitated saline, routinely used for HyCoSy. Two separate sonographers with identical ultrasound machines and model pelvises recorded images with varying degrees of agitated Lipiodol and ultrasound settings, in addition to capturing images with no fluid and agitated saline. Each test was performed in quadruplicate and in random order. Images were read by 47 blinded reporters and visibility reported on a scale of one (not visible) to five (clearly visible). The mean visibility score for images captured where the Lipiodol sample was agitated five times prior to injection to allow the formation of air microbubbles, regardless of ultrasound setting, were higher than or not different from that for agitated saline (all P>0.7 when not different, <0.001 when higher). Sonographic visualisation of agitated Lipiodol is similar or better than that of agitated saline. Lipiodol may therefore present a possibility for use with HyCoSy, with the added benefit of oil-based tubal flushing, avoiding the radiation exposure of HSG and concurrently providing pelvic soft-tissue evaluation.

Experience with Diagnostic Laparoscopy in the Evaluation of Tubal Factor Infertility

Context and Objectives: Tubal factor infertility accounts for a large portion of female factor infertility. Tubal disease is responsible for 25% - 35% of female infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Various modalities for investigating tubal factor infertility exist including: saline Infusion sonography (SIS), Hystero-contrast sonography (HyCoSy), hysterosalpingography (HSG) and laparoscopy with chromopertubation, the latter being the gold standard. The aim of this study was to determine the role of diagnostic laparoscopy in the evaluation of tubal factor in infertile women. Settings and Design: A retrospective descriptive study on all diagnostic laparoscopic procedures carried out to evaluate tubal factor infertility in the endoscopic gynecology unit of a tertiary-level hospital from 2010 to 2019. Methods: A retrospective descriptive study was conducted in the Department of Obstetrics and Gynaecology of a tertiary-level hospital in Ghana. A total of three hundred and ninety-one (391) records of all diagnostic laparoscopy procedures performed because of infertility in the endoscopic gynecology unit of a tertiary-level hospital between 2010 and 2019 were analyzed. Clients who underwent diagnostic laparoscopy to assess tubal factor infertility in the Obstetrics and Gynaecology Directorate of Komfo Anokye Teaching Hospital (KATH), Kumasi, from 2010 to 2019 were included in the study. Tubal patency was tested by laparoscopy and chromopertubation using methylene blue dye. The clinical characteristics of these women (age, parity, type of infertility), the intra-operative findings and complications were evaluated. Data on age, parity, type of infertility and intra operative findings were extracted using a proforma. Cases in which the bio-data or other clinical and laparoscopic findings were missing were excluded from the study. Ethical approval for the study was obtained from the Institutional Review Board (IRB) for Research and Development (R & D). A simple percentage method was used for statistical analysis. Results: A total of 391 women underwent diagnostic laparoscopy for investigation of tubal factor infertility between 2010 and 2019. The women’s mean age was 33.16 years. The youngest patient was 20 years and the oldest was 46 years. 232 (59.3%) patients were in primary infertility group while 159 (40.7%) patients were in secondary infertility group. 265 (66.8%) of the women were in the age group 20 - 35 years. The main laparoscopic findings for tubal factor were: 57.28% with bilateral tubal occlusion, 16.39% with unilateral tubal occlusion and 7.92% with hydrosalpinx. 18.41% had bilateral tubal patency. Other findings were identified during the laparoscopic procedure. For peritoneal abnormalities, 200 (51.15%) had normal findings, 184 (47.06%) had adhesions and 7 (1.79%) had peritoneal endometriosis. For uterine factor, 185 (47.31%) had normal uterus with no fibroids or adenomyosis, 202 (51.67%) had uterine fibroids, 2 (0.51%) had uterine anomaly and 2 (0.51%) had adenomyosis. For ovarian pathology, 13 (3.32%) had simple cyst, 2 (0.51%) had endometrioma, 184 (47.07%) had the ovaries involved in adhesions. 192 (49.10%) of patients had normal looking ovaries. There was no mortality or conversion to open laparotomy in this series. Conclusions: Unilateral and bilateral tubal blockade was detected in 73.67% of cases of infertile women. Diagnostic laparoscopy is a safe procedure.

Successful pregnancy for primary amenorrhea and recurrent implantation failure and the role of hysteroscopic adhesiolysis: a case report

BackgroundInfertility continues to be an enigmatic and emerging problem. Although in vitro fertilization has proved to be revolutionary and immensely beneficial to many people, it is far from perfect, and many women experience recurrent in vitro fertilization failures. There can be a multitude of factors involved in recurrent in vitro fertilization failures. The aim of this report was to explore the role of hysteroscopy in determining potential causes of in vitro fertilization failure and how the relevant hysteroscopic findings can address the issue of infertility in terms of a subsequent successful in vitro fertilization.Case presentationA 37-year-old white Arab woman with a history of eight in vitro fertilization failures and one curettage performed for a blighted ovum presented to our hospital because of inability to conceive. Her past medical history was significant for hypothyroidism and positive factor V Leiden. She underwent hystero contrast sonography, which revealed a normal uterine cavity with irregular fillings in the right corner. To explore this further, hysteroscopy was performed, which showed dense adhesions in the right upper corner and first-degree adhesions in the lower half of the uterus. After undergoing adhesiolysis and a cycle of estradiol valerate and progesterone, the patient successfully conceived twins.ConclusionsHysteroscopy may play an important role before or in conjunction with assisted reproductive techniques to help infertile women and couples achieve their goals of pregnancy and live birth of a child.

EP35.01: Study on the relationship between injection pressure of contrast agent and tubal patency during transvaginal hysterosalpingo‐contrast‐sonography

To evaluate the correspondence between contrast injection pressure and tubal patency during transvaginal hysterosalpingo-contrast sonography (HyCoSy). 238 female patients who were clinically diagnosed with infertility between November 2017 and May 2018 and underwent 4D HyCoSy to evaluate fallopian tubal patency were included in the study. During the process of HyCoSy, a pressure change curve of injection pressure was obtained. Other parameters such as the degree of pain of the patient, intrauterine reflux etc. were recorded. The tubal patency were analysed and determined by two experienced ultrasound physicians. Tubal patency is graded from 0 to 5 according to the severity of tubal blockage. The presentation of cure was also analysed. A total number of 153 cases were diagnosed as grade 0 with patent tube bilaterally. 26 patients were diagnosed as grade 1 with one partially blocked tube, 15 cases as grade 2 with both partially blocked tubes, 20 cases as grade 3 with one blocked tube and the other patent tube, 12 cases as grade 4 with one blocked tube and the otherartially blocked tube and 13 cases as grade 5 with blocked tube of oth sides. The peak pressure increased significantly (p < 0.0001). The pressure curve was generally flat in patients with patent tubes bilaterally and presented as slowly rising curve in patients with at least one partially blocked tube. While, for those with one or two blocked tubes, the curve was steep. The curve of contrast agent injection pressure can provide real-time change of intrauterine pressure change and the peak injection pressure for the first time. The presentation of pressure curve type, to some extent, can help diagnose the degree of tube patency.

Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography.

This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup.

Background Tubal patency testing is an essential part of female subfertility evaluation. Traditionally, hysterosalpingography (HSG) was the first step to evaluate tubal patency. However, during the past decade Hysterosalpingo-Contrast Sonography (HyCoSy) was introduced in order to avoid radiation exposure and Hysterosalpingo-Foam Sonography (HyFoSy) has been developed as a safe and less painful alternative. Objectives and Rationale The aim of this narrative review is to provide an overview of the currently available HyFoSy literature and related clinical aspects. Search Methods A literature search was conducted using PubMed and Embase from the introduction of HyFoSy to March 2019. Unfortunately, a meta-analysis was not possible due to a too small number of studies, being mutually incomparable for the various subjects of clinical aspects, even for the reliability as a test for tubal patency. Outcomes Nine small studies concluded that the accuracy and effectiveness as a test for tubal patency of 2D- and 3D-HyFoSy are comparable or even better than HSG or HyCoSy. With or without using Doppler techniques, 3D-HyFoSy does not seem to offer benefits above real-time 2D-HyFoSy. Five studies reported on pain and discomfort during HyFoSy, concluding that HyFoSy is a well-tolerated, less painful procedure compared to HSG, without a need for the use of analgesics. There are suggestions about an increased pregnancy rate in the first three cycles after the procedure but in no studies pregnancy outcome after HyFoSy was compared with other or no intervention. Wider Implications HyFoSy is a promising and safe alternative for HSG with regard to accuracy and effectiveness. HyFoSy lacks radiation and iodine exposure and is a well-tolerated and less painful procedure than HSG, without the need for analgesics. However more research is needed to make clear statements regarding a therapeutic effect of HyFoSy.

The Influencing Factors of Venous Intravasation During Transvaginal Four-dimensional Hysterosalpingo-contrast Sonography With SonoVue

Transvaginal 4-D hysterosalpingo-contrast sonography with SonoVue (TV 4-D HyCoSy) is the preferred imaging method for evaluating tubal patency. However, venous intravasation in 4-D HyCoSy may affect the diagnosis of tubal patency. The objective of this study was to analyze influencing factors of venous intravasation during TV 4-D HyCoSy. This study included 643 infertile patients who underwent TV 4-D HyCoSy. We analyzed the relationship between the incidence of venous intravasation and patients’ basic clinical data, endometrial thickness, inspection timing (clean day of menstruation) and tubal patency. A total of 169 (26.28%) patients exhibited intravasation during TV 4-D HyCoSy. The following are risk factors for venous intravation: secondary infertility, type C + C, type B + C and type B + B in bilateral fallopian tubal patency grouping; endometrial thickness ≤5.45 mm; and taking TV 4-D HyCoSy after menstruation ≤6 d. Infertility duration, intrauterine lesions, a history of pelvic inflammatory disease and a history of pelvic surgery were uncorrelated with venous intravasation. To reduce the incidence of venous intravasation, TV 4-D HyCoSy should be performed 7–10 d after menstruation or when endometrial thickness is thicker than 5.45 mm.

Combined Real-Time Three-Dimensional Hysterosalpingo-Contrast Sonography with B Mode Hysterosalpingo-Contrast Sonography in the Evaluation of Fallopian Tube Patency in Patients Undergoing Infertility Investigations

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.

Three-dimensional Hysterosalpingo Contrast Sonography with Lignosal as Contrast for Evaluation of Tubal Patency in the Infertile Women – An Observational Cohort Study

Objectives The objectives of the study were to evaluate the two-dimensional (2D)/three-dimensional (3D) hysterosalpingo contrast sonography (HyCoSy) using lignosal (a mixture of lignocaine 2% jelly with normal saline) as a contrast agent for assessing fallopian tubal patency in infertile patients. Materials and Methods After obtaining the Institutional Review Board permission, a single center prospective study was conducted to evaluate the validity of 3D-HyCoSy with lignosal to assess the patency of fallopian tubes in infertile women. In total 540 infertile patients were recruited for this study. Bilateral fallopian tube patency was confirmed when fallopian tubes were seen as echogenic tubular structures with peritoneal spill under real-time 3D/2D-HyCoSy. Results In the first phase of the study, 2D-HyCoSy without 3D acquisition was made in 20 patients (40 tubes). 2D-HyCoSy with lignosal contrast shown tubal patency in 95% and radiographic hysterosalpingography (HSG) resulted in 97.5% tubal patency with 5% inconclusive results by HyCoSy. In the second phase, data from 520 patients showed bilateral tubal patency in 463 patients (89.03%), unilateral tubal occlusion in 49 patients (9.42%), and bilateral tubal occlusion in eight patients (1.53%). No untoward side effects were noticed and reported by the patients during and after the HyCoSy procedure with lignosal. Conclusions 3D-HyCoSy with lignosal allowed the entire length of the fallopian tubes to be seen as contrast moved through the fallopian tubes to the fimbrial end. A “shower” of contrast around the ovaries is visualized confirming the peritoneal spill. Use of lignosal provides an alternative imaging method for evaluating the tubal patency in infertile patients.

Experience of combination of saline infusion with tubal contrast in sonography for subfertility evaluation at the largest public gynaecological tertiary referral centre in Singapore

IntroductionFallopian tube patency testing is the current standard of care for subfertility evaluation and commonly performed at our institution. Evidence supports HyFoSy as an alternative to hysterosalpingography (HSG) for outpatient tubal evaluation and it may be superior to saline hysterosalpingo-contrast sonography (HyCoSy) in excluding tubal occlusion. Our current practice is to combine HyFoSy in tubal assessment with saline infusion for uterine cavity assessment in a single study.AimsTo describe our combination HyFoSy-saline infusion protocol, pathology detected in our local population, tolerability and occurrence of pregnancy post-procedure.MethodologyRetrospective review of HyFoSy-saline infusion studies performed at our institution in 2017.ResultsStudy is performed between 7-14 days of the menstrual cycle. Targeted history and informed consent are obtained. Standard ultrasound pelvis is performed initially to look for uterine and adnexal masses and quantification of ovarian cysts. An intracervical catheter is then introduced and the uterine cavity is distended with sterile normal saline to visualise endometrial cavity structural anomalies and lesions. Finally foam contrast is instilled and flow within the fallopian tubes and spillage is observed in real time.Of 100 women, no cases were abandoned due to technical difficulty, severe pain or vasovagal episode. Three women (3%) cited significant pain with a median pain score of 5 and one (1%) required referral to the emergency department. In 3 women (3%), intravasation of tubal contrast occurred. Mean study time was 18 minutes.Mean age was 34 years. Seventy-seven women (77%) were nulliparous at the time of the study with 62 (62%) being nulligravida. Thirty-six (36%) had previous uterine intervention with 25 (25%) being previous D&C of which 6 (6%) were for pregnancy termination. Seven women (7%) had a history of miscarriage or ectopic pregnancy. Thirty-three (33%) studies found intra-cavitary findings: 15 (15%) demonstrated adhesions and 21 (21%) endometrial polyps; no submucosal fibroids. Ninety-four women (94%) had at least 1 patent tube with both tubes being patent in 76 (76%). Four women (4%) had salpingectomy due to previous EP or ovarian torsion. Hydrosalpinx was found in 3 women (3%). Thirty-two women (32%) had polycystic ovaries.Nine women (9%) gave birth successfully within 1 year of the study; 5 through assisted reproduction.ConclusionCombination of saline infusion with tubal contrast in sonography for subfertility evaluation offers improved visualisation of uterine cavity abnormalities whilst leveraging on the potential advantages of HyFoSy over HyCoSy. A small minority experience significant pain or contrast intravasation. Fallopian tube patency testing is the current standard of care for subfertility evaluation and commonly performed at our institution. Evidence supports HyFoSy as an alternative to hysterosalpingography (HSG) for outpatient tubal evaluation and it may be superior to saline hysterosalpingo-contrast sonography (HyCoSy) in excluding tubal occlusion. Our current practice is to combine HyFoSy in tubal assessment with saline infusion for uterine cavity assessment in a single study. To describe our combination HyFoSy-saline infusion protocol, pathology detected in our local population, tolerability and occurrence of pregnancy post-procedure. Retrospective review of HyFoSy-saline infusion studies performed at our institution in 2017. Study is performed between 7-14 days of the menstrual cycle. Targeted history and informed consent are obtained. Standard ultrasound pelvis is performed initially to look for uterine and adnexal masses and quantification of ovarian cysts. An intracervical catheter is then introduced and the uterine cavity is distended with sterile normal saline to visualise endometrial cavity structural anomalies and lesions. Finally foam contrast is instilled and flow within the fallopian tubes and spillage is observed in real time. Of 100 women, no cases were abandoned due to technical difficulty, severe pain or vasovagal episode. Three women (3%) cited significant pain with a median pain score of 5 and one (1%) required referral to the emergency department. In 3 women (3%), intravasation of tubal contrast occurred. Mean study time was 18 minutes. Mean age was 34 years. Seventy-seven women (77%) were nulliparous at the time of the study with 62 (62%) being nulligravida. Thirty-six (36%) had previous uterine intervention with 25 (25%) being previous D&C of which 6 (6%) were for pregnancy termination. Seven women (7%) had a history of miscarriage or ectopic pregnancy. Thirty-three (33%) studies found intra-cavitary findings: 15 (15%) demonstrated adhesions and 21 (21%) endometrial polyps; no submucosal fibroids. Ninety-four women (94%) had at least 1 patent tube with both tubes being patent in 76 (76%). Four women (4%) had salpingectomy due to previous EP or ovarian torsion. Hydrosalpinx was found in 3 women (3%). Thirty-two women (32%) had polycystic ovaries. Nine women (9%) gave birth successfully within 1 year of the study; 5 through assisted reproduction. Combination of saline infusion with tubal contrast in sonography for subfertility evaluation offers improved visualisation of uterine cavity abnormalities whilst leveraging on the potential advantages of HyFoSy over HyCoSy. A small minority experience significant pain or contrast intravasation.

Diagnostic value of transvaginal four-dimensional hysterosalpingo-contrast sonography combined with recanalization in patients with tubal infertility.

A retrospective study was designed to evaluate the diagnostic value of transvaginal four-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy) combined with recanalization versus laparoscopy for patients with tubal infertility. A total of 195 patients undergoing TVS 4D-HyCoSy were analyzed retrospectively. Of these, 72 patients underwent laparoscopy, which was the gold standard. The endpoints were coincidence rate (defined as a parameter consistent with results arising from TVS 4D-HyCoSy and laparoscopic examination using dye), sensitivity, specificity, positive predictive value, negative predictive value, and Youden index for TVS 4D-HyCoSy. A total of 385 fallopian tubes were assessed by TVS 4D-HyCoSy, of which 147 (38.2%) were tubal patency, 178 (46.2%) as partial tubal obstruction, and 60 (15.6%) as complete tubal obstruction. Of 195 patients, 72 patients with 144 fallopian tubes underwent laparoscopy and a total coincidence rate of 90.97% compared with TVS 4D-HyCoSy. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index for 4D-HyCoSy versus laparoscopy were 97.7%, 86.7%, 98.4%, 81.3%, and 0.84, respectively. TVS 4D-HyCoSy represents a highly useful method for diagnosing tubal patency. However, further large-scale studies are warranted to investigate our findings in patients with tubal infertility.

Intravasation Affects the Diagnostic Image Quality of Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography With SonoVue.

We aim to retrospectively analyze the diagnostic image quality of transvaginal 4-dimensional hysterosalpingo-contrast sonography from infertile patients and determine the significant influencing factors. A total of 445 patients visiting infertility clinics were included in the study, of which 167 were primary infertile and 278 were secondary infertile. The factors were recorded, including age; examination time; infertility type; history of pelvic inflammatory disease, pelvic surgery, intrauterine surgery, and ectopic pregnancy; endometrial thickness; uterine position; ovarian position; 2-dimensional image quality; intravasation quantity, position, and time; balloon volume; and the dosage of contrast agent or the sterile saline solution. All the factors were compared among different diagnostic image quality groups. The method of rank logistic regression analysis was adopted to analyze the risk factors affecting the diagnostic image quality. Among the 445 infertile patients, 124 (27.9%) patients had intravasation occur during transvaginal 4-dimensional hysterosalpingo-contrast sonography. The diagnostic image quality between the 2 sonographers was consistent (Cronbach's alpha, 0.993). Different intravasation quantities, positions, and times; increased of balloon volume; and history of pelvic surgery were substantial risk factors for the diagnostic image quality. The diagnostic image quality diminished with the increase of intravasation. In the patient with cornual intravasation, the diagnostic image quality was substantially worse than that with non-cornual intravasation. Moreover, early onset of intravasation seriously affected the diagnostic image quality. In conclusion, intravasation affected the diagnostic image quality, especially early cornual massive intravasation.

Higher Prevalence of Endometrial Polyps in Patients with Fallopian Tube Obstruction: A Case-control Study

To study the association between endometrial polyps and fallopian tube patency diagnosed by hysteroscopy, conventional histology, and 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy). A case-control study (Canadian Task Force classification II-2). A university hospital. A total of 323 women of reproductive age underwent 4D HyCoSy and hysteroscopy between January 2015 and December 2017. A retrospective analysis of the association of endometrial polyps and fallopian tube obstruction (n = 154) or patency (n = 169) in patients who underwent 4D HyCoSy. The prevalence of endometrial polyps was significantly higher in patients with bilateral fallopian tube obstruction than in patients with bilateral fallopian tube patency (42.9% [66/154] vs 20.1% [34/169], p <.0001). In univariate and multivariate analyses, the presence of endometrial polyps was found to be a risk factor for tubal obstruction with an odds ratio of 3.16 and 2.59, respectively. The prevalence of endometrial polyps is higher in infertile patients with fallopian tube obstruction than in patients with fallopian tube patency. History of endometrial polyps, ectopic pregnancy, and pelvic inflammatory disease are risk factors for tubal obstruction.

Assessment of the Influence on Spontaneous Pregnancy of Hysterosalpingo-Contrast Sonography

Objective Our objective was to explore whether the pregnancy rate (PR) was higher than usual after hysterosalpingo-contrast sonography (HyCoSy). Methods We conducted a prospective observational study of 1,008 infertility patients, all of whom were examined by HyCoSy. The expected time for spontaneous pregnancy was at least 180 days after the HyCoSy exams. There were three types of HyCoSy results: type I, defined as both fallopian tubes patent; type II, defined as one fallopian tube patent with obstruction in the other; and type III, defined as both fallopian tubes obstructed. During the HyCoSy examinations, we recorded the mobility of the ovaries, injective resistance, and contrast agent venous intravasation. Before the examinations, we recorded each patient's medical history, including maternal age, infertility type, median duration of menstrual cycle, dysmenorrhea, and parity number. Results The PR was 19.44% within 180 days after HyCoSy and it was significantly higher in the first 30 days (6.35%) (P <.01). The PR of type I was highest, with a rate of 32.01%, followed by the PR of type II (25.51%) and type III (15.04%) (P <.01). Univariate analysis showed that younger age, patency of both fallopian tubes, good ovarian mobility, and absence of injective resistance were positively related to the initiation of pregnancy (P <.01). Infertility type, median duration of menstrual cycle, dysmenorrhea, parity number, contrast agent venous intravasation, and identity of the sonographer were unrelated to pregnancy (P >.05). However, multivariate analysis showed that patency of both fallopian tubes and the absence of injective resistance were independently associated with pregnancy. Conclusion Some infertility patients conceived successfully and naturally not long after HyCoSy, most often in the first month after the examination. Multivariate analysis showed that patency of both fallopian tubes and the absence of injective resistance were independently factors associated with the ability to conceive after HyCoSy examination.

Influence Factors on Contrast Agent Venous Intravasation During Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography.

To explore the risk factors on contrast agent venous intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy). The TVS 4D-HyCoSy imaging data were collected from 276 female infertile patients. The correlation between endometrial thickness, days after menstruation, intrauterine intervention history, fallopian tubal patency degree, and contrast agent venous intravasation, respectively, was analyzed. In our study, the incidence of contrast agent venous intravasation was 13.04%. Endometrial thickness and days after menstruation were significantly associated with venous intravasation (P < .05). However, there was no significance for intrauterine intervention history and fallopian tube patency degree. Contrast agent intravasation during TVS 4D-HyCoSy is not infrequent. Performing TVS 4D-HyCoSy according to endometrial thickness and menstrual period could reduce intravasation incidence to some extent.

The value of injection pressure measurement during real-time three-dimensional hysterosalpingo-contrast sonography for assessing fallopian tube patency

Objective To explore the correlation between injection peak pressure and tubal patency during real-time three-dimensional hysterosalpingo-contrast sonography(RT 3D-HyCoSy). Methods One hundred and seven patients who were scheduled to undergo transvaginal RT 3D-HyCoSy with SonoVue contrast agent were included in the study. They were injected with contrast agent by an YLD-YZ-800 auto contrast agent injection device. The patients were divided into tubal patency included bilateral patency group, one side patency group and bilateral positive group according to imaging results. During the examination, the injection peak pressure was recorded to analyze whether there were significant differences among the three groups. Results The contrast agent injection peak pressures of bilateral patency group, one side patency group and bilateral positive group were (34.58±8.25)kPa, (44.85±10.05)kPa and (54.26±11.65)kPa, respectively. The differences of injection pressure among the three groups were statistically significant (F=38.732; P=0.000, 0.000, 0.033). The peak pressure was negatively correlated with tubal patency (r=-0.653, P=0.000). Conclusions Contrast agent injection peak pressure is associated with tubal patency in RT 3D-HyCoSy, and can be quantitatively measured to help for assessing fallopian tube patency. Key words: Ultrasonography, real-time three-dimensional; Contrast Media; Hysterosalpingography; Injection pressure; Fallopian tube patency

Use of atropine in four‐dimensional hysterosalpingo‐contrast sonography: Does it suppress pain during infertility examination?

This study aimed to ascertain if atropine is useful for suppressing the pain suffered during four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) when assessing infertility in women. A total of 252 patients were divided into 2 groups to receive or not receive atropine (0.5mg) injection 30minutes before 4D-HyCoSy. Pain was evaluated using a numerical rating scale (NRS): during 4D-HyCoSy; upon 2-dimensional transvaginal sonography; before catheter insertion; upon insertion and fixation of the catheter into the uterine cavity; 30minutes after 4D-HyCoSy. According to the degree of patency of Fallopian tubes, the 6 patterns observed were integrated further into 3 patient groups: all-negative (both Fallopian tubes were negative), positive-and-negative (one Fallopian tube showed patency and the other showed stenosis or non-patency), and all-positive (both Fallopian tubes showed stenosis or non-patency). We compared the NRS scores and prevalence of side-effects other than pain between the atropine-injection and non-atropine-injection groups within the three groups mentioned above. The NRS score showed no significant differences among the groups at any time point (all P>.05). The different prevalence of side-effects other than pain was significant between the atropine-injection and atropine-non-injection groups (P=.012). These data suggest that atropine does not reduce pain in patients during 4D-HyCoSy. However, atropine may reduce the prevalence of other side-effects during 4D-HyCoSy, which needs a further, large, prospective, multi-cohort study to verify.

Prospective Study of Concordance Between Hysterosalpingo-Contrast Sonography and Hysteroscopy for Evaluation of the Uterine Cavity in Patients Undergoing Infertility Studies.

The purpose of the study was to assess the accuracy of hysterosalpingo-contrast sonography (HyCoSy) for evaluation of the uterine cavity. Hysterosalpingo-contrast sonography was compared with hysteroscopy for assessment of the uterine cavity. This work was a descriptive prospective study to assess the concordance between pathologic intrauterine findings using the Cohen κ coefficient. Ninety infertile patients from Puerta de Hierro University Hospital were included in the study. They underwent HyCoSy between June 2016 and April 2017. Fifteen of them had pathologic findings in the uterine cavity during HyCoSy and therefore underwent hysteroscopy. Clinical and sonographic findings were compared in those 15 patients by to evaluate the agreement between both techniques. In this study, intrauterine sonographic findings on HyCoSy and hysteroscopic features of the uterine cavity reached 100% concordance, with a κ coefficient of 1.000 and a 100% agreement rate. Hysterosalpingo-contrast sonography permits a very accurate evaluation of the uterine cavity, which could be of interest for infertile patients who might be examined for tubal patency.

Hysterosalpingo-foam sonography (HyFoSy): Tolerability, safety and the occurrence of pregnancy post-procedure.

Fallopian tube patency testing is an essential part of infertility evaluation. Hysterosalpingo-contrast sonography (HyCoSy) has been described as reliable, well tolerated and safe compared to other modalities such as laparoscopy and a dye test or hysterosalpingography. Limited availability of the previously used contrast has led to the introduction of a foam contrast agent as an alternative. To assess the tolerability, safety and occurrence of pregnancy post-procedure of hysterosalpingo-foam sonography (HyFoSy). A retrospective cohort study of women who had a HyFoSy at Queensland Ultrasound for Women from March 2013 to February 2015. A questionnaire was sent to their referring doctor to identify any complications or subsequent pregnancies with or without artificial reproductive technology (ART) within six months of the HyFoSy. Of 200 women, four cases were abandoned due to difficulty introducing the intracervical catheter, severe discomfort or a vasovagal episode. Response from referring doctors for 155 women reported no post-procedural complication. One hundred and eleven women were followed up for at least six months. Twenty-four out of 59 women (40.7%) who had ART and 24 out of 52 women (46.2%) who did not have ART conceived. Fifty percent of women who were nulligravida at the time of investigation, found to have at least one patent fallopian tube, whose partner had a normal semen analysis, spontaneously conceived within the time of follow up. HyFoSy is well tolerated and safe. A preponderance of pregnancies in the first month after HyFoSy suggests that a therapeutic effect may exist.