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Hysterosalpingo contrast sonography (HyCoSy): let’s make the point!

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Abstract

Introduction

The accurate evaluation of tubal patency as well of the morphologic characteristics of the uterine cavity is a fundamental step in the diagnostic work-up for infertility. Hysteroscopy and laparoscopy and dye have long been regarded as the reference methods to assess uterine morphology and tubal patency, respectively. However, their technical and clinical limitations have supported the introduction of an emerging technique: hysterosalpingo contrast sonography (HyCoSy), which has recently been improved with the use of modern contrast agents and three-dimensional resolution.

Methods

A systematic literature search was performed in electronic databases (PubMed and Scopus). Key search terms included Hysterosalpingo contrast sonography (HyCoSy), Tubal patency, Infertility, Uterine cavity, Ultrasounds.

Results

HyCoSy has proved to be as reliable as laparoscopic techniques in the assessment of tubal patency and uterine morphology, and also it overcomes such major drawbacks as hospitalization, radiation exposure, anesthesia and use of iodinated contrast media. All in all, HyCoSy is considered as a safe and well tolerated outpatient procedure, which apparently favors the onset of spontaneous pregnancies.

Conclusion

This paper provides a comprehensive overview of the literature dealing with HyCoSy to support its use as a first-line technique in standard infertility work-up.

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References

  1. Spira A (1986) Epidemiology of human reproduction. Hum Reprod 1:111–115

    CAS  PubMed  Google Scholar 

  2. Crosignani PG, Rubin BL (2000) Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group. Hum Reprod 15:723–732

    Article  CAS  PubMed  Google Scholar 

  3. Reis MM, Soares SR, Cancado ML, Camargos AF (1998) Hysterosalpingo contrast sonography (HyCoSy) with SH U 454 (Echovist) for the assessment of tubal patency. Hum Reprod 13:3049–3052

    Article  CAS  PubMed  Google Scholar 

  4. Campbell S, Bourne TH, Tan SL, Collins WP (1994) Hysterosalpingo contrast sonography (HyCoSy) and its future role within the investigation of infertility in Europe. Ultrasound Obstet Gynecol 4:245–253

    Article  CAS  PubMed  Google Scholar 

  5. Ahinko-Hakamaa K, Huhtala H, Tinkanen H (2007) The validity of air and saline hysterosalpingo-contrast sonography in tubal patency investigation before insemination treatment. Eur J Obstet Gynecol Reprod Biol 132:83–87

    Article  PubMed  Google Scholar 

  6. Jeanty P, Besnard S, Arnold A, Turner C, Crum P (2000) Air-contrast sonohysterography as a first step assessment of tubal patency. J Ultrasound Med 19:519–527

    CAS  PubMed  Google Scholar 

  7. Alborzi S, Dehbashi S, Khodaee R (2003) Sonohysterosalpingographic screening for infertile patients. Int J Gynaecol Obstet 82:57–62

    Article  CAS  PubMed  Google Scholar 

  8. Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Battista Nardelli G (2003) Side effects and complications of sonohysterosalpingography. Fertil Steril 80:620–624

    Article  PubMed  Google Scholar 

  9. Exacoustos C, Zupi E, Carusotti C, Lanzi G, Marconi D, Arduini D (2003) Hysterosalpingo- contrast sonography compared with hysterosalpingography and laparoscopic dye perturbation to evaluate tubal patency. J Am Assoc Gynecol Laparosc 10:367–372

    Article  PubMed  Google Scholar 

  10. Watrelot A, Hamilton J, Grudzinskas JG (2003) Advances in the assessment of the uterus and fallopian tube function. Best Pract Res Clin Obstet Gynaecol 17:187–209

    Article  PubMed  Google Scholar 

  11. Dessole S, Capobianco G, Ambrosini G (2000) Timing of sonohysterography in menstruating women. Gynecol Obstet Invest 50:144

    Article  CAS  PubMed  Google Scholar 

  12. Dessole S, Farina M, Capobianco G, Nardelli GB, Ambrosini G, Meloni GB (2001) Determining the best catheter for sonohysterography. Fertil Steril 76:605–609

    Article  CAS  PubMed  Google Scholar 

  13. Radić V, Canić T, Valetić J, Duić Z (2005) Advantages and disadvantages of hysterosonosalpingography in the assessment of the reproductive status of uterine cavity and fallopian tubes. Eur J Radiol 53:268–273

    Article  PubMed  Google Scholar 

  14. Emanuel MH, Exalto N (2011) Hysterosalpingo-foam sonography (HyFoSy): a new technique to visualize tubal patency. Ultrasound Obstet Gynecol 37:497–499

    Article  Google Scholar 

  15. Soares SR, Barbosa dos Reis MMB, Camargos AF (2000) Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 73:406–411

    Article  CAS  PubMed  Google Scholar 

  16. Fedele L, Bianchi S, Dorta M, Brioschi D, Zanotti F, Vercellini P (1991) Transvaginal ultrasonography versus hysteroscopy in the diagnosis of uterine submucous myomas. Obstet Gynecol 77:745–748

    CAS  PubMed  Google Scholar 

  17. Widrich T, Bradley LD, Mitchinson AR, Collins RL (1996) Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol 174:1327–1334

    Article  CAS  PubMed  Google Scholar 

  18. Emanuel MH, Verdel MJ, Wamsteker K, Lammes FB (1995) A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications. Am J Obstet Gynecol 72:547–555

    Article  Google Scholar 

  19. Cohen SL, Valle RF (2000) Role of vaginal sonography and hysterosonography in the endoscopic treatment of uterine myomas. Fertil Steril 73:197–204

    Article  CAS  PubMed  Google Scholar 

  20. Saccardi C, Conte L, Fabris A, De Marchi F, Borghero A, Gizzo S, Litta P (2014) Hysteroscopic enucleation in toto of submucous type 2 myomas: long-term follow-up in women affected by menorrhagia. J Minim Invasive Gynecol 21:426–430

    Article  PubMed  Google Scholar 

  21. Cacciatore B, Ramsay T, Lehtovirta P, Ylöstalo P (1994) Transvaginal sonography and hysteroscopy in postmenopausal bleeding. Acta Obstet Gynecol Scand 73:413–416

    Article  CAS  PubMed  Google Scholar 

  22. Indman P (1995) Abnormal uterine bleeding: accuracy of vaginal probe ultrasound in predicting abnormal hysteroscopic findings. J Reprod Med 40:545–548

    CAS  PubMed  Google Scholar 

  23. Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA (2000) Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol 21:180–183

    CAS  PubMed  Google Scholar 

  24. Tjarks M, Van Voorhis BJ (2000) Treatment of endometrial polyps. Obstet Gynecol 96:886–889

    Article  CAS  PubMed  Google Scholar 

  25. Gizzo S, Saccardi C, Di Gangi S, Bertocco A, Vendemiati L, Righetto L, Patrelli TS, D’antona D, Nardelli GB (2014) Secondary amenorrhea in severe Asherman’s syndrome: step by step fertility retrieval by Bettocchi’s hysteroscope: some considerations. Minim Invasive Ther Allied Technol 23:115–119

    Article  PubMed  Google Scholar 

  26. Exalto N, Stappers C, van Raamsdonk LA, Emanuel MH (2007) Gel instillation sonohysterography: first experience with a new technique. Fertil Steril 87:152–155

    Article  PubMed  Google Scholar 

  27. Berger C, Sakowitz OW, Kiening KL, Schwab S (2005) Neurochemical monitoring of glycerol therapy in patients with ischemic brain edema. Stroke 36:e4–e6

    Article  CAS  PubMed  Google Scholar 

  28. Nilforoushan MR, Latkany RA, Speaker MG (2005) Effect of artificial tears on visual acuity. Am J Ophthalmol 140:830–835

    Article  PubMed  Google Scholar 

  29. Falk K, Holmdahl L, Halvarsson M, Larsson K, Lindman B, Bengmark S (1998) Polymers that reduce intraperitoneal adhesion formation. Br J Surg 85:1152–1156

    Article  Google Scholar 

  30. Elam JH, Elam M (1993) Surface modification of intravenous catheters to reduce local tissue reactions. Biomaterials 14:861–864

    Article  CAS  PubMed  Google Scholar 

  31. O’Brien JM, Houseman BA, Allen AA, Barton JR (2003) Methylcellulose gel is superior contrast agent for ultrasonographic examination of the cervix in obstetric patients. Ultrasound Obstet Gynecol 21:149–151

    Article  PubMed  Google Scholar 

  32. Nugent D, Watson AJ, Killick SR, Balen AH, Rutherford AJ (2002) A randomized controlled trial of tubal flushing with lipiodol for unexplained infertility. Fertil Steril 77:173–175

    Article  PubMed  Google Scholar 

  33. Giugliano E, Cagnazzo E, Bazzan E, Patella A, Marci R (2012) Hysterosalpingo-contrast sonography: is possible to quantify the therapeutic effect of a diagnostic test? Clin Exp Reprod Med 39:161–165

    Article  PubMed Central  PubMed  Google Scholar 

  34. Lindborg L, Thorburn J, Bergh C, Strandell A (2009) Influence of HyCoSy on spontaneous pregnancy: a randomized controlled trial. Hum Reprod 24:1075–1079

    Article  CAS  PubMed  Google Scholar 

  35. Van Schoubroeck D, Van den Bosch T, Meuleman C, Tomassetti C, D’Hooghe T, Timmerman D (2013) The use of a new gel foam for the evaluation of tubal patency. Gynecol Obstet Invest 75:152–156

    Article  PubMed  Google Scholar 

  36. Zhou L, Zhang X, Chen X, Liao L, Pan R, Zhou N, Di N (2012) Value of three-dimensional hysterosalpingo-contrast sonography with SonoVue in the assessment of tubal patency. Ultrasound Obstet Gynecol 40:93–98

    Article  CAS  PubMed  Google Scholar 

  37. Kiyokawa K, Masuda H, Fuyuki T, Koseki M, Uchida N, Fukuda T, Amemiya K, Shouka K, Suzuki K (2000) Three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) as an outpatient procedure to assess infertile women: a pilot study. Ultrasound Obstet Gynecol 16:648–654

    Article  CAS  PubMed  Google Scholar 

  38. Sladkevicius P, Ojha K, Campbell S, Nargund G (2000) Three-dimensional power Doppler imaging in the assessment of Fallopian tube patency. Ultrasound Obstet Gynecol 16:644–647

    Article  CAS  PubMed  Google Scholar 

  39. Chan CC, Ng EH, Tang OS, Chan KK, Ho PC (2005) Comparison of three-dimensional hysterosalpingo-contrast-sonography and diagnostic laparoscopy with chromopertubation in the assessment of tubal patency for the investigation of subfertility. Acta Obstet Gynecol Scand 84:909–913

    Article  PubMed  Google Scholar 

  40. Hamed HO, Shahin AY, Elsamman AM (2009) Hysterosalpingo-contrast sonography versus radiographic hystero-salpingography in the evaluation of tubal patency. Int J Gynecol Obstet 105:215–217

    Article  Google Scholar 

  41. Exacoustos C, Di Giovanni A, Szabolcs B, Romeo V, Romanini ME, Luciano D, Zupi E, Arduini D (2013) Automated three-dimensional coded contrast hysterosalpingo-contrast-sonography: feasibility in office tubal patency testing. Ultrasound Obstet Gynecol 41:328–335

    Article  CAS  PubMed  Google Scholar 

  42. Lanzani C, Savasi V, Leone FP, Ratti M, Ferrazzi E (2009) Two-dimensional HyCoSy with contrast tuned imaging technology and a second-generation contrast media for the assessment of tubal patency in an infertility program. Fertil Steril 92:1158–1161

    Article  CAS  PubMed  Google Scholar 

  43. Jeanty P, Besnard S, Arnold A, Turner C, Crum P (2000) Air-contrast sonohysterography as a first step assessment of tubal patency. J Ultrasound Med 19:519–527

    CAS  PubMed  Google Scholar 

  44. Reis MM, Soares SR, Cancado ML, Camargos AF (1998) Hysterosalpingo contrast sonography (HyCoSy) with SH U 454 (Echovist) for the assessment of tubal patency. Hum Reprod 13:3049–3052

    Article  CAS  PubMed  Google Scholar 

  45. Graziano A, Lo Monte G, Soave I, Caserta D, Moscarini M, Marci R (2013) Sonohysterosalpingography: a suitable choice in infertility workup. J Med Ultrasonics 40:225–229

    Article  Google Scholar 

  46. Randolph JF Jr, Ying YK, Maier DB, Schmidt CL, Riddick DH (1986) Comparison of real-time ultrasonography, hysterosalpingography, and laparoscopy/hysteroscopy in the evaluation of uterine abnormalities and tubal patency. Fertil Steril 46:828–832

    PubMed  Google Scholar 

  47. Gaucherand P, Piacenza JM, Salle B, Rudigoz RC (1995) Sonohysterography of the uterine cavity: preliminary investigations. J Clin Ultrasound 23:339–348

    Article  CAS  PubMed  Google Scholar 

  48. Marci R, Marcucci I, Marcucci AA, Pacini N, Salacone P, Sebastianelli A, Caponecchia L, Lo Monte G, Rago R (2013) Hysterosalpingocontrast sonography (HyCoSy): evaluation of the pain perception, side effects and complications. BMC Med Imaging 23(13):28

    Article  Google Scholar 

  49. Ayida G, Kennedy S, Barlow D, Chamberlain P (1996) A comparison of patient tolerance of hysterosalpingo-contrast sonography (HyCoSy) with Echovist-200 and X-ray hysterosalpingography for outpatient investigation of infertile women. Ultrasound Obstet Gynecol 7:201–204

    Article  CAS  PubMed  Google Scholar 

  50. Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S (2000) Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 74:1029–1034

    Article  CAS  PubMed  Google Scholar 

  51. Stacey C, Bown C, Manhire A, Rose D (2000) HyCoSy: as good as claimed? Br J Radiol 73:133–136

    Article  CAS  PubMed  Google Scholar 

  52. Socolov D, Boian I, Boiculese L, Tamba B, Anghelache-Lupascu I, Socolov R (2010) Comparison of the pain experienced by infertile women undergoing hysterosalpingo contrast sonography or radiographic hysterosalpingography. Int J Gynaecol Obstet 111:256–259

    Article  PubMed  Google Scholar 

  53. ACOG Bulletin: Infertility. Number 125;Feb 1989

  54. Savelli L, Pollastri P, Guerrini M, Villa G, Manuzzi L, Mabrouk M, Rossi S, Seracchioli R (2009) Tolerability, side effects, and complications of hysterosalpingocontrast sonography (HyCoSy). Fertil Steril 92:1481–1486

    Article  PubMed  Google Scholar 

  55. Spalding H, Martikainen H, Tekay A, Jouppila P (1997) A randomized study comparing air to Echovist as a contrast medium in the assessment of tubal patency in infertile women using transvaginal salpingosonography. Hum Reprod 12:2461–2464

    Article  CAS  PubMed  Google Scholar 

  56. Berger C, Sakowitz OW, Kiening KL, Schwab S (2005) Neurochemical monitoring of glycerol therapy in patients with ischemic brain edema. Stroke 36:e4–e6

    Article  CAS  PubMed  Google Scholar 

  57. Boudghène FP, Bazot M, Robert Y, Perrot N, Rocourt N, Antoine JM, Morris H, Leroy JL, Uzan S, Bigot JM (2001) Assessment of Fallopian tube patency by HyCoSy: comparison of a positive contrast agent with saline solution. Ultrasound Obstet Gynecol 18:525–530

    Article  PubMed  Google Scholar 

  58. Luciano DE, Exacoustos C, Johns DA, Luciano AA (2011) Can hysterosalpingo-contrast sonography replace hysterosalpingography in confirming tubal blockage after hysteroscopic sterilization and in the evaluation of the uterus and tubes in infertile patients? Am J Obstet Gynecol 204(79):e1–e5

    PubMed  Google Scholar 

  59. Volpi E, Zuccaro G, Patriarca A, Rustichelli S, Sismondi P (1996) Transvaginal sonographic tubal patency testing using air and saline solution as contrast media in a routine infertility clinic setting. Ultrasound Obstet Gynecol 7:43–48

    Article  CAS  PubMed  Google Scholar 

  60. Holz K, Becker R, Schurmann R (1007) Ultrasound in the investigation of tubal patency. A meta-analysis of three comparative studies of Echovist-200 including, women. Zentralbl Gynakol 1997(119):366–373

    Google Scholar 

  61. Hamilton JA, Larson AJ, Lower AM, Hasnain S, Grudzinskas JG (1998) Evaluation of the performance of hysterosalpingo contrast sonography in 500 consecutive unselected infertile women. Hum Reprod 13:1519–1526

    Article  CAS  PubMed  Google Scholar 

  62. Exacoustos C, Zupi E, Szabolcs B, Amoroso C, Di Giovanni A, Romanini ME, Arduini D (2009) Contrast-tuned imaging and second-generation contrast agent SonoVue: a new ultrasound approach to evaluation of tubal patency. J Minim Invasive Gynecol 16:437–444

    Article  PubMed  Google Scholar 

  63. Van den Bosch T, Verguts J, Daemen A, Gevaert O, Domali E, Claerhout F, Vandenbroucke V, De Moor B, Deprest J, Timmerman D (2008) Pain experienced during transvaginal ultrasound, saline contrast sonohysterography, hysteroscopy and office sampling: a comparative study. Ultrasound Obstet Gynecol 31:346–351

    Article  PubMed  Google Scholar 

  64. Shahid N, Ahluwalia A, Briggs S, Gupta S (2005) An audit of patients investigated by hysterosalpingo-contrast-sonography (HyCoSy) for infertility. J Obstet Gynaecol 25:275–278

    Article  CAS  PubMed  Google Scholar 

  65. Guney M, Oral B, Bayhan G, Mungan T (2007) Intrauterine lidocaine infusion for pain relief during saline solution infusion sonohysterography: a randomized, controlled trial. J Minim Invasive Gynecol 14:304–310

    Article  PubMed  Google Scholar 

  66. Moro F, Selvaggi L, Sagnella F, Morciano A, Martinez D, Gangale MF, Ciardulli A, Palla C, Uras ML, De Feo E, Boccia S, Tropea A, Lanzone A, Apa R (2012) Could antispasmodic drug reduce pain during hysterosalpingo-contrast sonography (HyCoSy) in infertile patients? A randomized double-blind clinical trial. Ultrasound Obstet Gynecol 39:260–265

    Article  CAS  PubMed  Google Scholar 

  67. Fenzl V (2012) Effect of different ultrasound contrast materials and temperatures on patient comfort during intrauterine and tubal assessment for infertility. Eur J Radiol 81:4143–4145

    Article  PubMed  Google Scholar 

  68. Loffer FD (1995) Complications of hysteroscopy: their cause, prevention, and correction. J Am Assoc Gynecol Laparosc 3:11–26

    Article  CAS  PubMed  Google Scholar 

  69. Bracco PL, Vassallo AM, Armetano G (1996) Infectious complications of diagnostic hysteroscopy. Minerva Ginecol 48:293–298

    CAS  PubMed  Google Scholar 

  70. Cooper JM, Brady RM (2000) Intraoperative and early postoperative complications of operative hysteroscopy. Obstet Gynecol Clin North Am 27:347–366

    Article  CAS  PubMed  Google Scholar 

  71. Tuveng JM, Vold I, Jerve F, Eng J, Skaug K, Eyolfsson O (1985) Hysterosalpingography: value in estimating tubal function, and risk of infectious complications. Acta Eur Fertil 16:125–128

    CAS  PubMed  Google Scholar 

  72. Forsey JP, Caul EO, Paul ID, Hull MG (1990) Chlamydia trachomatis, tubal disease and the incidence of symptomatic and asymptomatic infection following hysterosalpingography. Hum Reprod 5:444–447

    CAS  PubMed  Google Scholar 

  73. Chenia F, Hofmeyr GJ, Moolla S, Oratis P (1997) Sonographic hydrotubation using agitated saline: a new technique for improving fallopian tube visualization. Br J Radiol 70:833–836

    Article  CAS  PubMed  Google Scholar 

  74. Wahby O, Sobrero AJ, Epstein JA (1966) Hysterosalpingography in relation to pregnancy and its outcome in infertile women. Fertil Steril 17:520–530

    CAS  PubMed  Google Scholar 

  75. Luttjeboer F, Harada T, Hughes E, Johnson N, Lilford R, Mol BW (2007) Tubal flushing for subfertility. Cochrane Database Syst Rev (3):CD003718

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Lo Monte, G., Capobianco, G., Piva, I. et al. Hysterosalpingo contrast sonography (HyCoSy): let’s make the point!. Arch Gynecol Obstet 291, 19–30 (2015). https://doi.org/10.1007/s00404-014-3465-4

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