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

Abstract

Objective: Investigate potential factors associated with non-visualisation of tubal patency during Hysterosalpingo-Foam-Sonography (HyFoSy).

Study design: This 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.

Results: 137 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).

Conclusion: HyFoSy 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. DISCIPLINE: gynaecology, infertility.

Keywords: Hysterosalpingo-Foam-Sonography (HyFoSy); misdiagnosis; tubal patency.