Diagnostic accuracy study comparing hysterosalpingo-foamsonography and hysterosalpingography for Fallopian tube patency assessment

Abstract

Tubal factor is one of the main etiologies in couples with fertility issues. Current evidence suggests that Hysterosalpingo-Foam Sonography test (HyFoSy) should be implanted as the Fallopian tubes patency assessment technique of reference. The aim of this study is to compare the diagnostic accuracy of HyFoSy in tubal patency testing with the traditional hysterosalpngography (HSG) for establishing a new diagnostic strategy in infertility patients and to highlight the latest updates on this topic trying to raise awareness about the benefits put forward by HyFoSy. Prospective observational diagnostic accuracy was performed in IVI-RMA Seville, a private fertility clinic, in which 106 women undergoing a preconceptionally visit were recruited. All of them had low risk for tubal disease, had performed an HSG and were negative for Chlamydia trachomatis antibody. Main outcome measures were tubal patency and pain grade. Assessment of tubal patency by HyFoSy showed a total concordance with the results of the previous HSG in 72.6% (n = 77), and a total discordance for 4.7% (n = 6), with the inter-test agreement Kappa equal to 0.57, which means moderate concordance. Among the patients, 59.1% did not report pain during the procedure, while the remaining 48.1% indicated pain in different degrees; patients usually report less pain and only 6.6% described more pain with HyFoSy than with HSG (OR 6.57 (CI 95% 3.11–13.89). Summarizing all the results, it can be concluded that HyFoSy is in moderate concordance with HSG regarding tubal patency results and it is a less painful technique than HSG. HyFoSy is more economical, safer and can be performed in an exam room only equipped with an ultrasound scanner. Based on these results, HyFoSy could be the first-choice diagnostic option to assess tubal patency in patients with low risk of tubal disease.