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Armijo-Sánchez A, Santamaría-López E, Fernández-Sánchez M, Galiano-Gutiérrez N, Mantrana-Bermejo E. Sequential-contingent strategy for fallopian tube evaluation using hysterosalpingo foam sonography: a cost analysis. Quant Imaging Med Surg 2024; 14:540-547. [PMID: 38223069 PMCID: PMC10784089 DOI: 10.21037/qims-23-816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/30/2023] [Indexed: 01/16/2024]
Abstract
Background Tubal pathology is the etiological factor in 20% of couples with female infertility. Historically, diagnostic evaluation of the fallopian tubes has been performed by means of hysterosalpingography (HSG). Hysterosonosalpingography with EXEM® foam is a recent technique with supposedly comparable effectiveness to HSG, but with better tolerability for patients. Methods Tubal patency was assessed in patients who were candidates for intrauterine insemination (IUI) between January 2020 and July 2021. (I) Hysterosonosalpingography with EXEM® foam. (II) If the patient had both tubes patent, IUI was proposed. In case of inconclusive or pathological results, HSG was performed. (III) If the HSG concludes tubal patency, IUI is proposed. On the other hand, if it results in tubal obstruction, in vitro fertilization (IVF) is proposed. Results Assessment of tubal patency by HSG showed concordance with previous Hysterosonosalpingography with EXEM® foam results in 45.5% (n=15) of cases of unilateral obstruction and 66.7% (n=6) of cases of bilateral obstruction. When we compare the total cost of HSG (€54,899.46) with the sum of patients who only required Hysterosonosalpingography with EXEM® foam together with those who underwent both tests (€45,575.96), it shows that the latter represents a cost benefit strategy (cost difference €9,323.50). Conclusions Our results suggest a benefit of €9,323.50 when performing the contingent sequential strategy, in case of pathological or inconclusive results, compared to performing a systematic HSG in all patients. Patients with an obstructive hysterosalpingogram with EXEM® and a patent hysterosalpingogram will be the subgroup that will benefit the most, as IUI can be proposed instead of IVF. In addition, there is a benefit in terms of optimizing the medical procedure, hospital visits and speeding up the time to start assisted reproductive technology (ART).
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Affiliation(s)
- Alberto Armijo-Sánchez
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
| | - Esther Santamaría-López
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
| | - Manuel Fernández-Sánchez
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Pablo de Olavide University, Seville, Spain
- Department of Surgery, Sevilla University, Seville, Spain
| | - Noelia Galiano-Gutiérrez
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
| | - Elena Mantrana-Bermejo
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
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Xu Z, Wang Y, Sun J, Chen S, Yan Z, Lin C, Shu J. Evaluation of tubal patency by hysterosalpingo-contrast Sonography (HyCoSy): Controversies, dilemmas and considerations. Heliyon 2023; 9:e17461. [PMID: 37539233 PMCID: PMC10395035 DOI: 10.1016/j.heliyon.2023.e17461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Evaluation of tubal patency is one of the vital steps in the process of female infertility management. Hysterosalpingo-contrast Sonography (HyCoSy) has become the first-line recommendation for evaluating tubal patency. However, there remain some controversies and dilemmas relevant to the evaluation of tubal patency by HyCosy, with no effective solution has been proposed or no consensus has been reached. Herein, combined with previous research and clinical experience, we conclude and analyze these controversies and dilemmas, aiming at offering our perspective on the opportunities and challenges which are faced by HyCosy.
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Affiliation(s)
- Zining Xu
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yaoting Wang
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Sun
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuangxi Chen
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zou Yan
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chen Lin
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jing Shu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
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Melcer Y, Shamir-Kaholi N, Vainer-Rotbart S, Pekar-Zlotin M, Youngster M, Gat I, Maymon R. Spontaneous pregnancy rates in infertile women after sequential hydrosonography and hysterosalpingo-foam sonography. Eur J Obstet Gynecol Reprod Biol 2022; 271:219-222. [PMID: 35231747 DOI: 10.1016/j.ejogrb.2022.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the clinical pregnancy rate following sequential hydrosonography and hysterosalpingo-foam sonography (HyFoSy) in tubal patency assessment among women undergoing infertility work-up. STUDY DESIGN Prospective follow-up of women referred to our department between July 2019 and October 2020. Sequential hydrosonography and HyFoSy were carried out. RESULTS Out of 250 having the procedure, 100 women were excluded from study due to limited infertility, semen abnormal or not examined, evaluation for social egg freezing or they were single. Of the remaining 150 women, 48 (32%) conceived during a 10-24 months follow-up period: 17 (11%) conceived naturally and 7 (4.7%) by IUI. The mean time to conception was 5.5 ± 5.4 months and the pregnancy rate was 52% within 6 months. Among the spontaneous pregnancies 47% occurred within a month and 76% within 3 months. CONCLUSION Sequential hydrosonography and HyFoSy is a promising method for assessing the uterine cavity and tubal patency in women undergoing infertility workup. The findings suggest that the procedure may increase the chance of a spontaneous pregnancy following the procedure. Given the other known advantages of sequential hydrosonography and HyFoSy, this test is worth including in the initial workup for infertile patients.
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Affiliation(s)
- Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Neta Shamir-Kaholi
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirah Vainer-Rotbart
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Youngster
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hager M, Ott J, Göbl C, Holzer I, Seemann R, Kurz C, Parry JP. Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion. Arch Gynecol Obstet 2021; 304:1073-1080. [PMID: 33625597 PMCID: PMC8429386 DOI: 10.1007/s00404-021-05993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/02/2021] [Indexed: 11/05/2022]
Abstract
Purpose To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.
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Affiliation(s)
- Marlene Hager
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Christian Göbl
- Clinical Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Iris Holzer
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rudolf Seemann
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Christine Kurz
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - John Preston Parry
- Parryscope® and Positive Steps Fertility, Madison, MS, USA.,Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
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Vitale SG, Carugno J, Riemma G, Török P, Cianci S, De Franciscis P, Parry JP. Hysteroscopy for Assessing Fallopian Tubal Obstruction: A Systematic Review and Diagnostic Test Accuracy Meta-analysis. J Minim Invasive Gynecol 2020; 28:769-778. [PMID: 33246040 DOI: 10.1016/j.jmig.2020.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/20/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of hysteroscopy compared with that of laparoscopic chromopertubation for the detection of fallopian tubal obstruction. DATA SOURCES An electronic search from inception to March 31, 2020, was performed in Medline, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials. METHODS OF STUDY SELECTION This diagnostic accuracy meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesizing Evidence from Diagnostic Accuracy Tests recommendations. A combination of the following Medical Subject Headings terms and keywords was included in the search strategy: "hysteroscopy[MeSH]," "tubal obstruction," "tubal patency," "tubal dysfunction," and "tubal blockage." Quality assessment of the included studies was conducted using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (University of Bristol, Bristol, United Kingdom). Publication bias was evaluated by means of the Deek funnel plot asymmetry test. The following outcomes were analyzed: diagnostic odds ratio, area under hierarchical summary receiver operating characteristic and area under receiver operating characteristic curve, sensitivity, specificity, and positive and negative likelihood ratios. TABULATION, INTEGRATION, AND RESULTS Six studies comparing hysteroscopy with laparoscopic chromopertubation were included in the meta-analysis. After pooling all the studies, the diagnostic odds ratio was 43. The evaluated area under receiver operating characteristic curve was 0.93, correlating with high diagnostic accuracy for the index test. Sensitivity and specificity were 88% and 85%, respectively. In addition, the positive and negative likelihood ratios were 5.88 and 0.16, respectively. CONCLUSION Hysteroscopic techniques are highly accurate and sensitive for detecting fallopian tubal obstruction. Interventional assessment enhances diagnostic accuracy compared with observational assessment, as does the office setting compared with the operating room. Additional studies, along with a refinement of the techniques, could facilitate the widespread use of hysteroscopic techniques for the detection of fallopian tube occlusion.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr. Vitale).
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, Miller School of Medicine, University of Miami, Miami, Florida (Dr. Carugno)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy (Drs. Riemma, Cianci, and De Franciscis)
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, Debrecen, Hungary (Dr. Török)
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy (Drs. Riemma, Cianci, and De Franciscis)
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy (Drs. Riemma, Cianci, and De Franciscis)
| | - John Preston Parry
- Parryscope and Positive Steps Fertility, Madison, and Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi (Dr. Parry)
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Engels V, Medina M, Antolín E, Ros C, Amaro A, De-Guirior C, Manzour N, Sotillo L, De la Cuesta R, Rodríguez R, San-Frutos L, Peralta S, Martin-Martínez A, Alcázar JL. Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study. J Gynecol Obstet Hum Reprod 2020; 50:102004. [PMID: 33242678 DOI: 10.1016/j.jogoh.2020.102004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODS This was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTS Nine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21-45) years and median body mass index was 23 (range, 16-41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1-16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0-10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSION HYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.
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Affiliation(s)
- V Engels
- Hospital Universitario Puerta de Hierro Majadahonda, Spain.
| | - M Medina
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
| | - E Antolín
- Hospital Materno Infantil La Paz, Spain
| | - C Ros
- Hospital Clinic Barcelona, Spain
| | - A Amaro
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
| | - C De-Guirior
- Hospital Materno Infantil La Paz, Spain; Hospital Clinic Barcelona, Spain
| | - N Manzour
- Clínica Universitaria De Navarra, Spain
| | - L Sotillo
- Hospital Materno Infantil La Paz, Spain
| | - R De la Cuesta
- Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | | | - L San-Frutos
- Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - S Peralta
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
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Liu Y, Zhang N, He Y, Shi J, Zhou M, Xu J, Liu H. Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography. BMC Pregnancy Childbirth 2020; 20:638. [PMID: 33081754 PMCID: PMC7574424 DOI: 10.1186/s12884-020-03315-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception. However, Few studies have evaluated the influencing factors of spontaneous conception in 4D-HyCoSy and suggested ways to choose treatment options after 4D-HyCoSy. The study was to evaluate the correlation between spontaneous conception outcome and the patients' clinical characteristics as well as tubal patency in infertile women to provide reference on ways to manage the patient after 4D-HyCoSy. METHODS This was a retrospective study and analysis of two hundred and eighty three (283) infertile patients who underwent a 4D-HyCoSy between December 2014 and October 2017 in our center. Eligible patients were those whose partners semen parameters were normal when based on World Health Organization (WHO) criteria, and had spontaneous conception without clinical interventions after 4D-HyCoSy. RESULT(S) One hundred and sixteen patients (40.9%) conceived spontaneously and the mean conception time was (8.8 ± 0.3) months. Within a year after 4D-HyCoSy, the spontaneous conception rate was highest in type VI(62.5%), followed by type IV (46.2%), type III (44.4%), type V (39.4%), type II (33.9%) and type I (14.8%). With Cox regression analysis, two factors associated with spontaneous conception outcome appeared to increase spontaneous conception rate: patients with type IV or type VI tubes and duration of infertility less than 2 years. The age, type of infertility, multiparas, history of pelvic surgery, history of uterine cavity operation, uterine fibromyomata and polycystic ovary were unrelated to spontaneous conception outcome after 4D-HyCoSy. CONCLUSION(S) This study showed that some infertile women could succeed in spontaneous conception after 4D-HyCoSy. Hence, We recommend the usage of 4D-HyCoSy as first line for tubal patency test and infertile patients should be advised to accept 4D-HyCoSy examination as soon as possible. Expectant treatment of about 8-9 months is reported to be feasible for infertile women whose 4D-HyCoSy findings showed one tube patency or poor patency. Alternatively, an immediate clinical intervention is recommended for those with bilateral obstructed tubes .
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Affiliation(s)
- Yu Liu
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Ning Zhang
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni He
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Jiayao Shi
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China
| | - Meijun Zhou
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China
| | - Jingjiao Xu
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China
| | - Hongmei Liu
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China.
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Lörincz J, Molnár S, Herman T, Vitale SG, Jashanjeet S, Lampé R, Kardos L, Török P. Predictive value of bubble sign for tubal patency during office hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2020; 253:58-60. [PMID: 32777542 DOI: 10.1016/j.ejogrb.2020.07.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our purpose was to investigate the predictive value of visible air bubble sign for real tubal patency during hysteroscopic procedures. METHODS In this cross-sectional study, clinical data of 61 infertile women who underwent diagnostic hysteroscopy and laparoscopy have been analysed. RESULTS Mean age of patients was 33.45 ± 3.25 years. Bubble sign for the detection of patency demonstrated 73 % (95 % CI: 57-86 %) sensitivity, 70 % (95 % CI: 46-88 %) specificity, a positive predictive value of 83 % (95 % CI: 67-94 %), and a negative predictive value of 56 % (95 % CI: 35-76 %). CONCLUSIONS A visible tubal "flow" of air bubbles during hysteroscopy was not accurate in the prediction of tubal patency.
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Affiliation(s)
- Judit Lörincz
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Hungary.
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Singh Jashanjeet
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - László Kardos
- University of Debrecen, Kenézy Gyula Teaching Hospital, Department of Clinical Pharmacology, Infectology and Allergology, Hungary.
| | - Péter Török
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
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9
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Alcázar JL, Martinez A, Duarte M, Welly A, Marín A, Calle A, Garrido R, Pascual MA, Guerriero S. Two-dimensional hysterosalpingo-contrast-sonography compared to three/four-dimensional hysterosalpingo-contrast-sonography for the assessment of tubal occlusion in women with infertility/subfertility: a systematic review with meta-analysis. HUM FERTIL 2020; 25:43-55. [PMID: 32484066 DOI: 10.1080/14647273.2020.1769204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this meta-analysis, we aimed to compare the diagnostic accuracy of 2D- and 3D/4D-HyCoSy for the assessment of tubal occlusion in women with infertility, using a laparoscopic tubal chromoperturbation dye test as the reference standard. Studies assessing 2D- and 3D/4D-HyCoSy for the assessment of tubal occlusion in women with infertility were searched from January 1990 to April 2019 using Medline and Web of Science databases by three of the authors, using the terms: 'hysterosalpingo-contrast-sonography', 'sonohysterosalpingography', 'HyCoSy', 'HyFoSy', 'three-dimensional', 'four-dimensional', 'ultrasound', 'tubal patency' and 'tubal occlusion'. Data quality was determined using the QUADAS-2 tool. Thirty articles were included; twenty-one studies used 2D-HyCoSy to assess tubal occlusion, six used 3D/4D-HyCoSy, one study used both techniques but in a different set of patients and two used both techniques in the same patients. The risk of bias for most studies was low as determined by QUADAS-2, except for the patient selection domain. Overall, pooled estimated sensitivity and specificity of 2D-HyCoSy were 86% (95% CI = 80%-91%) and 94% (95% CI = 90%-96%), respectively. The corresponding figures for 3D/4D HyCoSy were 95% (95% CI = 89%-98%) and 89% (95% CI = 82%-94%). High heterogeneity was found for both sensitivity and specificity. No statistically significant differences were found between the methods (p = 0.13). We concluded that 2D-HyCoSy has a similar diagnostic performance to 3D/4D-HyCoSy.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Andrea Martinez
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Manuel Duarte
- Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico, Valencia, Spain
| | - Andry Welly
- Department of Obstetrics and Gynecology, Dr Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
| | - Antonio Marín
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Raquel Garrido
- Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico, Valencia, Spain
| | - Maria 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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Shi J, Li S, Wu H, He Y, Yi W, Xu J, Liu H, Guan Y. The Influencing Factors of Venous Intravasation During Transvaginal Four-dimensional Hysterosalpingo-contrast Sonography With SonoVue. Ultrasound Med Biol 2019; 45:2273-2280. [PMID: 31201020 DOI: 10.1016/j.ultrasmedbio.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/17/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Transvaginal 4-D hysterosalpingo-contrast sonography with SonoVue (TV 4-D HyCoSy) is the preferred imaging method for evaluating tubal patency. However, venous intravasation in 4-D HyCoSy may affect the diagnosis of tubal patency. The objective of this study was to analyze influencing factors of venous intravasation during TV 4-D HyCoSy. This study included 643 infertile patients who underwent TV 4-D HyCoSy. We analyzed the relationship between the incidence of venous intravasation and patients' basic clinical data, endometrial thickness, inspection timing (clean day of menstruation) and tubal patency. A total of 169 (26.28%) patients exhibited intravasation during TV 4-D HyCoSy. The following are risk factors for venous intravation: secondary infertility, type C + C, type B + C and type B + B in bilateral fallopian tubal patency grouping; endometrial thickness ≤5.45 mm; and taking TV 4-D HyCoSy after menstruation ≤6 d. Infertility duration, intrauterine lesions, a history of pelvic inflammatory disease and a history of pelvic surgery were uncorrelated with venous intravasation. To reduce the incidence of venous intravasation, TV 4-D HyCoSy should be performed 7-10 d after menstruation or when endometrial thickness is thicker than 5.45 mm.
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Affiliation(s)
- Jiayao Shi
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - Sushu Li
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Haorong Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Yanni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - Wenhong Yi
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Jingjiao Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Hongmei Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China.
| | - Ying Guan
- Department of Biostastics, Southern Medical University, Guangzhou, Guangdong, P.R. China
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11
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Agrawal N, Fayyaz S. Can hysterolaparoscopic mediated chromopertubation obviate the need for hysterosalpingography for proximal tubal blockage?: An experience at a single tertiary care center. J Gynecol Obstet Hum Reprod 2018; 48:241-245. [PMID: 29689309 DOI: 10.1016/j.jogoh.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the diagnostic performance for tubal patency by chromopertubation and hysterosalpingography in the female infertile patients. METHODS We prospectively evaluated 103 female patients (age range 19-35 years; mean age 27.60 years) diagnosed as infertile, underwent hysterosalpingography (HSG) for tubal patency and uterine pathology during initial diagnostic work-up. All the enlisted patients fulfilled the criteria of infertility and these also underwent hysterolaparoscopic chromopertubation (CPT). The results of HSG were compared with the reference standard using CPT. RESULTS Out of 103 female infertile patients, 60 (58.2%) were of primary and rest of them 43 (41.8%) secondary infertile patients. HSG showed abnormalities in tubal patency in 69/103 (∼67%) patients. The detected abnormalities were distributed in 40/60 (66.6%) primary and 29/43 (67.4%) secondary infertile patients. On comparison to HSG with CPT (reference standard) for tubal blockage detection, it was found that HSG was true positive (TP) in 38 patients, true negative in 34 patients, false positive in 31 patients and FN in 0 patients. We found that for detection of tubal blockage, the sensitivity, specificity, PPV, NPV and accuracy of HSG was 100.00%, 52.31%, 36.89%, 57.07% and 67% respectively. Tubal occlusion detected on HSG and CPT showed a moderate agreement (weighted kappa - 0.447; 95% CI -0.312 to 0.583). In present study, no patient shows tubal blockage in CPT while HSG was normal. CONCLUSION We concluded that hysterolaparoscopic mediated chromopertubation not only diagnostic but also therapeutic, so it can obviate the need of hysterosalpingography.
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Affiliation(s)
- Namita Agrawal
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India.
| | - S Fayyaz
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India
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Cochet T, Gatimel N, Moreau J, Cohade C, Fajau C, Lesourd F, Parinaud J, Léandri R. Effect of unilateral tubal abnormalities on the results of intrauterine inseminations. Reprod Biomed Online 2017; 35:314-317. [PMID: 28668273 DOI: 10.1016/j.rbmo.2017.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 11/25/2022]
Abstract
A total of 101 patients with one normal tube were compared with 117 patients with two normal tubes to assess the effect of unilateral tubal abnormalities on the results of intrauterine inseminations. The clinical pregnancy and live birth rates seemed to reduce by one-half in almost all types of abnormality, suggesting that these patients should be preferentially treated with IVF.
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Affiliation(s)
| | - Nicolas Gatimel
- Médecine de la Reproduction, CHU Toulouse, 31059 Toulouse, France; Groupe de Recherche en Fertilité Humaine EA 3694, Université Paul Sabatier, 31059 Toulouse, France
| | - Jessika Moreau
- Médecine de la Reproduction, CHU Toulouse, 31059 Toulouse, France; Groupe de Recherche en Fertilité Humaine EA 3694, Université Paul Sabatier, 31059 Toulouse, France
| | | | - Carole Fajau
- Médecine de la Reproduction, CHU Toulouse, 31059 Toulouse, France
| | - Florence Lesourd
- Médecine de la Reproduction, CHU Toulouse, 31059 Toulouse, France
| | - Jean Parinaud
- Médecine de la Reproduction, CHU Toulouse, 31059 Toulouse, France; Groupe de Recherche en Fertilité Humaine EA 3694, Université Paul Sabatier, 31059 Toulouse, France.
| | - Roger Léandri
- Médecine de la Reproduction, CHU Toulouse, 31059 Toulouse, France; Groupe de Recherche en Fertilité Humaine EA 3694, Université Paul Sabatier, 31059 Toulouse, France
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13
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Soliman AA, Shaalan W, Abdel-Dayem T, Awad EE, Elkassar Y, Lüdders D, Malik E, Sallam HN. Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy. Eur J Obstet Gynecol Reprod Biol 2015; 195:83-87. [PMID: 26479436 DOI: 10.1016/j.ejogrb.2015.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/16/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. STUDY DESIGN A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. RESULTS Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. CONCLUSIONS Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup.
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Affiliation(s)
- Amr A Soliman
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt; Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany.
| | - Waleed Shaalan
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Tamer Abdel-Dayem
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Elsayed Elbadawy Awad
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Yasser Elkassar
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Dörte Lüdders
- Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | - Eduard Malik
- Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | - Hassan N Sallam
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
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14
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Graziano A, Lo Monte G, Soave I, Caserta D, Moscarini M, Marci R. Sonohysterosalpingography: a suitable choice in infertility workup. J Med Ultrason (2001) 2012; 40:225-9. [PMID: 27277240 DOI: 10.1007/s10396-012-0417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 10/22/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the efficacy, compliance, and cost effectiveness of sonohysterosalpingography (HyCoSy) compared with hysteroscopy for uterine cavity evaluation and compared with RX-hysterosalpingography (RX-HSG) for tubal patency determination. METHODS Three hundred and eight infertile patients underwent HyCoSy, hysteroscopy, and RX-HSG. We compared sensitivity, specificity, positive and negative predictive values (PPV and NPV), discomfort level, and cost of all three procedures. RESULTS Sensitivity, specificity, PPV, and NPV were higher for HyCoSy than for hysteroscopy but the differences were not significant. HyCoSy also has the same accuracy as RX-HSG. Pain perception and cost were higher for RX-HSG and hysteroscopy than for HyCoSy. CONCLUSIONS HyCoSy can be regarded as a procedure for initial evaluation of the uterine cavity and of tubal patency in infertile patients.
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Affiliation(s)
- Angela Graziano
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy
| | - Giuseppe Lo Monte
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy
| | - Ilaria Soave
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy
| | - Donatella Caserta
- Department of Woman Health and Territory's Medicine, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy
| | - Massimo Moscarini
- Department of Woman Health and Territory's Medicine, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy
| | - Roberto Marci
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy.
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