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Kamphuis D, van Eekelen R, van Welie N, Dreyer K, van Rijswijk J, van Hooff MHA, de Bruin JP, Verhoeve HR, Mol F, van Baal WM, Traas MAF, van Peperstraten AM, Manger AP, Gianotten J, de Koning CH, Koning AMH, Bayram N, van der Ham DP, Vrouenraets FPJM, Kalafusova M, van de Laar BIG, Kaijser J, Lambeek AF, Meijer WJ, Broekmans FJM, Valkenburg O, van der Voet LF, van Disseldorp J, Lambers MJ, Tros R, Lambalk CB, Stoker J, van Wely M, Bossuyt PMM, Mol BWJ, Mijatovic V. Hysterosalpingo-foam sonography versus hysterosalpingography during fertility work-up: an economic evaluation alongside a randomized controlled trial. Hum Reprod 2024; 39:1222-1230. [PMID: 38600625 PMCID: PMC11144974 DOI: 10.1093/humrep/deae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/29/2024] [Indexed: 04/12/2024] Open
Abstract
STUDY QUESTION What are the costs and effects of tubal patency testing by hysterosalpingo-foam sonography (HyFoSy) compared to hysterosalpingography (HSG) in infertile women during the fertility work-up? SUMMARY ANSWER During the fertility work-up, clinical management based on the test results of HyFoSy leads to slightly lower, though not statistically significant, live birth rates, at lower costs, compared to management based on HSG results. WHAT IS KNOWN ALREADY Traditionally, tubal patency testing during the fertility work-up is performed by HSG. The FOAM trial, formally a non-inferiority study, showed that management decisions based on the results of HyFoSy resulted in a comparable live birth rate at 12 months compared to HSG (46% versus 47%; difference -1.2%, 95% CI: -3.4% to 1.5%; P = 0.27). Compared to HSG, HyFoSy is associated with significantly less pain, it lacks ionizing radiation and exposure to iodinated contrast medium. Moreover, HyFoSy can be performed by a gynaecologist during a one-stop fertility work-up. To our knowledge, the costs of both strategies have never been compared. STUDY DESIGN, SIZE, DURATION We performed an economic evaluation alongside the FOAM trial, a randomized multicenter study conducted in the Netherlands. Participating infertile women underwent, both HyFoSy and HSG, in a randomized order. The results of both tests were compared and women with discordant test results were randomly allocated to management based on the results of one of the tests. The follow-up period was twelve months. PARTICIPANTS/MATERIALS, SETTING, METHODS We studied 1160 infertile women (18-41 years) scheduled for tubal patency testing. The primary outcome was ongoing pregnancy leading to live birth. The economic evaluation compared costs and effects of management based on either test within 12 months. We calculated incremental cost-effectiveness ratios (ICERs): the difference in total costs and chance of live birth. Data were analyzed using the intention to treat principle. MAIN RESULTS AND THE ROLE OF CHANCE Between May 2015 and January 2019, 1026 of the 1160 women underwent both tubal tests and had data available: 747 women with concordant results (48% live births), 136 with inconclusive results (40% live births), and 143 with discordant results (41% had a live birth after management based on HyFoSy results versus 49% with live birth after management based on HSG results). When comparing the two strategies-management based on HyfoSy results versus HSG results-the estimated chance of live birth was 46% after HyFoSy versus 47% after HSG (difference -1.2%; 95% CI: -3.4% to 1.5%). For the procedures itself, HyFoSy cost €136 and HSG €280. When costs of additional fertility treatments were incorporated, the mean total costs per couple were €3307 for the HyFoSy strategy and €3427 for the HSG strategy (mean difference €-119; 95% CI: €-125 to €-114). So, while HyFoSy led to lower costs per couple, live birth rates were also slightly lower. The ICER was €10 042, meaning that by using HyFoSy instead of HSG we would save €10 042 per each additional live birth lost. LIMITATIONS, REASONS FOR CAUTION When interpreting the results of this study, it needs to be considered that there was a considerable uncertainty around the ICER, and that the direct fertility enhancing effect of both tubal patency tests was not incorporated as women underwent both tubal patency tests in this study. WIDER IMPLICATION OF THE FINDINGS Compared to clinical management based on HSG results, management guided by HyFoSy leads to slightly lower live birth rates (though not statistically significant) at lower costs, less pain, without ionizing radiation and iodinated contrast exposure. Further research on the comparison of the direct fertility-enhancing effect of both tubal patency tests is needed. STUDY FUNDING/COMPETING INTEREST(S) FOAM trial was an investigator-initiated study, funded by ZonMw, a Dutch organization for Health Research and Development (project number 837001504). IQ Medical Ventures provided the ExEm®-FOAM kits free of charge. The funders had no role in study design, collection, analysis, and interpretation of the data. K.D. reports travel-and speakers fees from Guerbet and her department received research grants from Guerbet outside the submitted work. H.R.V. received consulting-and travel fee from Ferring. A.M.v.P. reports received consulting fee from DEKRA and fee for an expert meeting from Ferring, both outside the submitted work. C.H.d.K. received travel fee from Merck. F.J.M.B. received a grant from Merck and speakers fee from Besins Healthcare. F.J.M.B. is a member of the advisory board of Merck and Ferring. J.v.D. reported speakers fee from Ferring. J.S. reports a research agreement with Takeda and consultancy for Sanofi on MR of motility outside the submitted work. M.v.W. received a travel grant from Oxford Press in the role of deputy editor for Human Reproduction and participates in a DSMB as independent methodologist in obstetrics studies in which she has no other role. B.W.M. received an investigator grant from NHMRC GNT1176437. B.W.M. reports consultancy for ObsEva, Merck, Guerbet, iGenomix, and Merck KGaA and travel support from Merck KGaA. V.M. received research grants from Guerbet, Merck, and Ferring and travel and speakers fees from Guerbet. The other authors do not report conflicts of interest. TRIAL REGISTRATION NUMBER International Clinical Trials Registry Platform No. NTR4746.
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Affiliation(s)
- Danah Kamphuis
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Rik van Eekelen
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC location Universitity of Amsterdam, Amsterdam, The Netherlands
| | - Nienke van Welie
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Joukje van Rijswijk
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Machiel H A van Hooff
- Department of Obstetrics and Gynaecology, Franciscus Hospital, Rotterdam, The Netherlands
| | - Jan Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Harold R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
| | - Femke Mol
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC location Universitity of Amsterdam, Amsterdam, The Netherlands
| | | | - Maaike A F Traas
- Department of Obstetrics and Gynaecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Arno M van Peperstraten
- Department of Obstetrics and Gynaecology, Rivierenland Hospital, Tiel, The Netherlands
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arentje P Manger
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - Judith Gianotten
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Cornelia H de Koning
- Department of Obstetrics and Gynaecology, Tergooi Medical Center, Hilversum, The Netherlands
| | - Aafke M H Koning
- Department of Obstetrics and Gynaecology, Amstelland Hospital, Amstelveen, The Netherlands
| | - Neriman Bayram
- Department of Obstetrics and Gynaecology, Zaans Medical Centre, Zaandam, The Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | | | - Michaela Kalafusova
- Department of Obstetrics and Gynaecology, Refaja Hospital, Stadskanaal, The Netherlands
| | | | - Jeroen Kaijser
- Department of Obstetrics and Gynaecology, Ikazia Medical Center, Rotterdam, The Netherlands
| | - Arjon F Lambeek
- Department of Obstetrics and Gynaecology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Wouter J Meijer
- Department of Obstetrics and Gynaecology, Gelre Hospitals, Zutphen, The Netherlands
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Dijklander Hospital, Hoorn, The Netherlands
| | - Olivier Valkenburg
- Department of Reproductive Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lucy F van der Voet
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - Jeroen van Disseldorp
- Department of Obstetrics and Gynaecology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Marieke J Lambers
- Department of Obstetrics and Gynaecology, Dijklander Hospital, Hoorn, The Netherlands
| | - Rachel Tros
- Department of Obstetrics and Gynaecology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC location Universitity of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women’s Health Research, University of Aberdeen, King’s College, Aberdeen, UK
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Hardel AS, Flye Sainte Marie H, Lorrain S, Iacobelli S, Lazaro G, Boukerrou M, Tran PL. [Pregnancy after intrauterine insemination following hysterosalpingo-foam-sonography or hysterosalpingography]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00093-X. [PMID: 38547932 DOI: 10.1016/j.gofs.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To compare clinical pregnancy rates following intrauterine insemination performed after hysterosalpingography (HSG) or hysterosalpingo-foam-sonography (HyFoSy). MATERIAL AND METHODS This is a retrospective study including 242 intrauterine insemination (IUI) performed between 2015 and 2020 at the fertility center of the Reunion Island. Among these inseminations, 121 with previous HSG and 121 with previous HyFoSy were matched. The main outcome of interest was clinical pregnancy rate. Secondary outcomes were birth rate and time to pregnancy after tubal patency test. RESULTS The pregnancy rate after insemination was 9.9% for the HSG group and 11.6% for the HyFoSy group, with no statistically significant difference between the groups (P=0.66). The live birth rate was similar in the two groups (7.4% for HSG and 10.7% for HyFoSy; P=0.37). Over half (57.1%) of the pregnancies occurred within 6 months after HyFoSy, whereas only 8.3% after HSG. CONCLUSION IUI results are not influenced by HyFoSy compared to HSG with regard to the pregnancy rates. Use of HyFoSy in infertility assessment allows global evaluation and more rapid adapted management. This approach could optimize management of patients undergoing IUI.
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Affiliation(s)
- Anne-Sophie Hardel
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion
| | - Hélène Flye Sainte Marie
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion
| | - Simon Lorrain
- Centre d'études périnatales de l'Océan Indien (UR 7388), université de la Réunion, Saint-Pierre, Réunion
| | - Silvia Iacobelli
- Centre d'études périnatales de l'Océan Indien (UR 7388), université de la Réunion, Saint-Pierre, Réunion; Réanimation néonatale et pédiatrique, néonatologie, centre hospitalier universitaire Sud Réunion, Saint-Pierre cedex, Réunion
| | - Glorianne Lazaro
- Empartners, 760 Newtown Yardely Rd Suite 112, Newtown, PA, 18940, États-Unis
| | - Malik Boukerrou
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion; Centre d'études périnatales de l'Océan Indien (UR 7388), université de la Réunion, Saint-Pierre, Réunion; Université de la Réunion, UFR santé, 40, avenue de Soweto, Terre Sainte, BP 373, 97455 Saint-Pierre cedex, Réunion
| | - Phuong Lien Tran
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion; Université de la Réunion, UFR santé, 40, avenue de Soweto, Terre Sainte, BP 373, 97455 Saint-Pierre cedex, Réunion; Inserm, CIC 1410, Reunion University Hospital, 97448 Saint-Pierre, Réunion.
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Factors Associated with a Post-Procedure Spontaneous Pregnancy after a Hysterosapingo-Foam-Sonography (HyFoSy): Results from a Multicenter Observational Study. Diagnostics (Basel) 2023; 13:diagnostics13030504. [PMID: 36766609 PMCID: PMC9914236 DOI: 10.3390/diagnostics13030504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tubal patency testing constitutes an essential part of infertility work-up. Hysterosalpingo-foam-sonography (HyFoSy) is currently one of the best tests for assessing tubal patency. The objective of our study was to evaluate the post-procedure rate of spontaneous pregnancy among infertile women submitted for an HyFoSy exam with ExEm® foam and the factors associated with this. METHODS Multicenter, prospective, observational study performed at six Spanish centers for gynecologic sonography and human reproduction. From December 2015 to June 2021, 799 infertile women underwent HyFoSy registration consecutively. The patients' information was collected from their medical records. Multivariable regression analyses were performed, controlling for age, etiology, and time of sterility. The main outcome was to measure post-procedure spontaneous pregnancy rates and the factors associated with the achievement of pregnancy. RESULTS 201 (26.5%) women got spontaneous conception (SC group), whereas 557 (73.5%) women did not get pregnant (non-spontaneous conception group, NSC). The median time for reaching SC after HyFoSy was 4 months (CI 95% 3.1-4.9), 18.9% of them occurring the same month of the procedure. Couples with less than 18 months of infertility were 93% more likely to get pregnant after HyFoSy (OR 1.93, 95% CI 1.34-2.81; p < 0.001); SC were two times more frequent in women under 35 years with unexplained infertility (OR 2.22, 95% CI 1.07-4.65; P0.033). CONCLUSION After HyFoSy, one in four patients got pregnant within the next twelve months. Couples with shorter infertility time, unexplained infertility, and women under 35 years are more likely to achieve SC after HyFoSy.
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Factors associated with non-visualisation of tubal patency during Hysterosalpingo-Foam-Sonography. J Gynecol Obstet Hum Reprod 2022; 51:102379. [DOI: 10.1016/j.jogoh.2022.102379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/19/2022] [Accepted: 04/09/2022] [Indexed: 11/24/2022]
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Serrano González L, Pérez-Medina T, Bueno Olalla B, Royuela A, De La Cuesta MDLR, Saéz de la Mata D, Domínguez-Franjo E, Calles-Sastre L, Engels V. Is hysterosalpingo-foam sonography (HyFoSy) more tolerable in terms of pain and anxiety than hysterosalpingography (HSG)? A prospective real-world setting multicentre study. BMC Womens Health 2022; 22:41. [PMID: 35152893 PMCID: PMC9909448 DOI: 10.1186/s12905-022-01606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/25/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In 60% of sterile couples a female factor is present, with these being tubal factors in 30-50% of cases. A tubal patency test is also required in women without a male partner undergoing fertility treatment. Thus, an accurate, safe and tolerable technique should be available. The aim of this study is to determine and to compare hysterosalpingo-foam sonography (HyFoSy) and hysterosalpingography (HSG) tolerability in terms of pain and anxiety. METHODS This is a prospective real-world setting multicentre study conducted in two tertiary hospitals in Madrid. 210 infertile women/women without a male partner looking to get pregnant were recruited; 111 for the HyFoSy group and 99 for the HSG group. Tolerability was measured in terms of anxiety by the State Trait Anxiety Inventory (STAI) and pain by the Visual Analogue Scale (VAS). RESULTS Median VAS score in HyFoSy group was 2 (P25; P75: 1; 3) versus 5 (4; 8) in HSG group, p < 0.001. The median State-STAI score in the HSG group was 18 points (10; 26) versus 10 (7; 16) in the HyFoSy group (p < 0.001); the median Trait-STAI score in the HSG group was 15 (11; 21) versus 13 (9; 17) in the HyFoSy group (p = 0.044). CONCLUSIONS HyFoSy shows higher tolerability to both: pain and anxiety. It is related to less pain and less post-test anxiety than HSG.
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Affiliation(s)
- Lucía Serrano González
- Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222, Majadahonda, Madrid, Spain. .,Department of Gynaecology and Obstetrics, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034, Madrid, Madrid, Spain.
| | - Tirso Pérez-Medina
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - Beatriz Bueno Olalla
- Department of Gynaecology and Obstetrics, Infanta Sofía University Hospital, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid Spain
| | - Ana Royuela
- grid.466571.70000 0004 1756 6246Biostatistics Unit, Biomedical Research Institute Puerta de Hierro-Segovia de Arana (CIBERESP) ES, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - María de los Reyes De La Cuesta
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - David Saéz de la Mata
- Department of Gynaecology and Obstetrics, Infanta Sofía University Hospital, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid Spain
| | - Esther Domínguez-Franjo
- Department of Radio Diagnosis, Infanta Sofía University Hospital, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid Spain
| | - Laura Calles-Sastre
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - Virginia Engels
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
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Levaillant JM, Rabourdin A, Pinto M, Hurteloup E, Vernet T, Pasquier M, Moquet PY, Massin N. HyFoSy for Fallopian tube test, the how: Sonographic signs and standardization with a simple classification. J Gynecol Obstet Hum Reprod 2022; 51:102307. [PMID: 34986385 DOI: 10.1016/j.jogoh.2021.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/26/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jean-Marc Levaillant
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France; Hôpital Privé Armand Brillard, Groupe Ramsay Générale de Santé, Nogent-sur-Marne, France; Clinique la Sagesse, Rennes, France
| | - Anaïs Rabourdin
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Mélodie Pinto
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Edwige Hurteloup
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Thibaut Vernet
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Maud Pasquier
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | | | - Nathalie Massin
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France.
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Ramos J, Caligara C, Santamaría-López E, González-Ravina C, Prados N, Carranza F, Blasco V, Fernández-Sánchez M. Diagnostic Accuracy Study Comparing Hysterosalpingo-Foam Sonography and Hysterosalpingography for Fallopian Tube Patency Assessment. J Clin Med 2021; 10:jcm10184169. [PMID: 34575278 PMCID: PMC8466769 DOI: 10.3390/jcm10184169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Simplified ultrasound-based infertility protocols that appear to provide enough information to plan effective management have been described. Thus, the objective of this study is to compare the diagnostic accuracy of the hysterosalpingo-foam sonography (HyFoSy) in tubal patency testing with the traditional hysterosalpngography (HSG) for establishing a new diagnostic strategy in infertility. Material and Methods: Prospective observational diagnostic accuracy was performed in 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. Results: Evaluation 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)). Clinical outcomes after performing HyFoSy were not affected. Conclusions: HyFoSy is in concordance with HSG regarding tubal patency results and it is a less painful technique than HSG. HyFoSy is more economical 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.
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Affiliation(s)
- Julia Ramos
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Cinzia Caligara
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Esther Santamaría-López
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Cristina González-Ravina
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, ES-41013 Seville, Spain
- Correspondence: ; Tel.: +34-954-286-274; Fax: +34-954-285-084
| | - Nicolás Prados
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, ES-41013 Seville, Spain
| | - Francisco Carranza
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Víctor Blasco
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Manuel Fernández-Sánchez
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, ES-41013 Seville, Spain
- Department of Surgery, Universidad de Sevilla, ES-41004 Seville, Spain
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8
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Boned-López J, Alcázar JL, Errasti T, Ruiz-Zambrana A, Rodriguez I, Pascual MA, Guerriero S. Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 304:1389-1398. [PMID: 34417840 DOI: 10.1007/s00404-021-06188-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the frequency of severe pain perception during hysterosalpingo-contrast sonography (HyCoSy) in infertile women and to assess whether there are differences in the frequency of associated pain according to the contrast used. DESIGN Systematic review and meta-analysis. PATIENTS Women undergoing HyCoSy due to infertility. INTERVENTIONS Searches were carried out in two databases (Pubmed and Web of Science). We included prospective or retrospective cohort observational studies that specified the type of contrast used during HyCoSy and reported data regarding the number of patients who perceived severe pain during the procedure and the scale used for pain perception score. MAIN OUTCOME MEASURES Pooled frequency of severe pain perception during HyCoSy and the pooled frequency of severe pain perception based on the contrast used. RESULTS Twenty-nine studies were included in this meta-analysis including a total of 7139 patients. In 10 studies, Saline solution with air was used as contrast EchoVist™ was used in ten studies, in five studies, SonoVue™ was used and in four studies, ExEm-Foam™ was used as contrast. Pooled estimated frequency of severe pain perception during HyCoSy was 6% (95% CI 4-9). No statistically significant differences have been described regarding frequency of severe pain perception in relation to the different contrasts used. CONCLUSIONS HyCoSy is a tolerable outpatient procedure. We did not find any evidence that one specific contrast was better tolerated than any other was.
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Affiliation(s)
- Jordi Boned-López
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain.
| | - Tania Errasti
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Alvaro Ruiz-Zambrana
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Ignacio Rodriguez
- Epidemiology and Statistics Unit, Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - María Angela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
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