Elsevier

Journal of Minimally Invasive Gynecology

Volume 21, Issue 6, November–December 2014, Pages 994-998
Journal of Minimally Invasive Gynecology

Review Article
Contrast Ultrasonography for Tubal Patency

https://doi.org/10.1016/j.jmig.2014.05.017Get rights and content

Abstract

Evaluation of tubal patency is an essential part of a fertility workup. Laparoscopy with chromopertubation in conjunction with hysteroscopy is the gold standard in evaluation of tubal patency and the uterine cavity. In this review article we describe a newer method for evaluation of the uterus and fallopian tubes, that is, hysterosalpingo–contrast sonography (HyCoSy). Accuracy of HyCoSy for tubal patency has been shown to be comparable to that with hysterosalpingography (HSG) when compared with laparoscopic chromopertubation. Sensitivity ranges from 75% to 96%, and specificity from 67% to 100%. HyCoSy is also accurate when compared with HSG in determining tubal occlusion after hysteroscopic sterilization, with 88% of patients stating they would prefer to undergo the tubal occlusion test in their gynecologist's office. Because HyCoSy also includes evaluation of the uterine cavity with saline solution–enhanced sonohysterography, accuracy in evaluating the uterine cavity is >90% when compared with hysteroscopy. HyCoSy enables the gynecologist to complete a fertility workup in the office in the most minimally invasive way. HyCoSy is well tolerated and has been suggested in the literature to replace HSG for evaluation of tubal disease in the subfertile population.

Section snippets

Performance of HyCoSy

HyCoSy is performed in the same way as saline solution–infused ultrasonography. Before performing HyCoSy it is important to screen women for chlamydia and related pelvic infections. Exclusion criteria include ongoing pregnancy; reproductive tract cancer; pelvic and vaginal infections; presence of tubal disease (hydrosalpinx, acute salpingitis) detectable via ultrasound; presence of risks factors such as heart disease, in particular heart shunt hypertension; and ictus. HyCoSy is better and more

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Cited by (53)

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

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    Disadvantages include radiation exposure, risk of allergy to iodinated contrast, inability to evaluate the ovaries, poor diagnostic efficacy for uterine malformations and low tolerance of the examination [6,7]. Ultrasound alternatives were thus developed : HyCoSy (Hysterosalpingo-Contrast-Sonography) [8] and more recently HyFoSy (Hysterosalpingo-Foam-Sonography) [9]; coupled with the use of fluid contrast agents such as ExEm® gel also these allow for real-time imaging of hyperechoic flow through the tubes. With a diagnostic sensitivity comparable to laparoscopy and HSG [10,11], tubal contrast ultrasonography also allows for an exhaustive assessment of the pelvis, and simplifies the procedure in a simple, non-invasive and non-irradiating intervention for the patient [7,12–14].

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    Hysterosalpingo-contrast sonography (HyCoSy) involves instilling echogenic contrast, typically an agitated air and saline mixture, into the uterus with real-time US to observe the material distending the uterine cavity, filling the fallopian tubes, and spilling out over the adjacent ovary [53]. Accuracy of HyCoSy is similar to HSG when compared with laparoscopy with chromopertubation in determining tubal patency with sensitivity of 75% to 96% and specificity of 67% to 100% when compared directly with laparoscopy with chromopertubation [54]. It has been proposed that TVUS with 3-D imaging of the uterus and ovaries followed by SIS and HyCoSy with agitated saline can be performed in one session as a comprehensive infertility examination [42].

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Disclosures: None declared.

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