Hysterosalpingo-Contrast Sonography Compared with Hysterosalpingography and Laparoscopic Dye Pertubation to Evaluate Tubal Patency (original) (raw)

2003, The Journal of the American Association of Gynecologic Laparoscopists

Some degree of tubal pathology, resulting in occlusion of one or both tubes, is found in one of three infertile women. Conventional diagnostic imaging procedures such as radiographs, hysterosalpingography (HSG), and laparoscopy with dye pertubation are associated with several risks including invasiveness and exposure to iodinated contrast media or ionizing radiation. Transvaginal ultrasound accurately diagnoses various pelvic conditions that can be responsible for infertility and that are not detectable by HSG, but it does not permit evaluation of the patency of the fallopian tubes. Hysterosalpingo-contrast sonography (HyCoSy) was introduced in the early 1980s for studying tubal patency. It is a simple, easy, outpatient technique that hardly ever requires premedication or hospitalization. In initial studies, saline solution was passed transcervically before performing transabdominal sonography. 1, 2 From the finding of free fluid in the pouch of Douglas, these authors indirectly deduced patency of at least one tube. Saline solution has the advantage of being completely safe and inexpensive. However, although it is excellent for visualizing intrauterine pathology (sonohysterography), it does not seem to be particularly accurate in determining the state of fallopian tubes and their patency. 3-5 Association of transvaginal ultrasonography with color Doppler sonography and/or ultrasound positive contrast media increases the accuracy of this method. Studies comparing HyCoSy and HSG in the diagnosis of tubal patency reported conflicting results, probably due to different ultrasound techniques and contrast media. Contrast media (Echovist, Levovist, Infoson) 5-10 facilitate evaluation of tubal patency by HyCoSy; however, they are expensive, not available in many countries, and not always accepted by patients. Some authors 11-13