***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Purpose : Our goal was to assess , with a prospect i ve study , the role of hysterosalpingo-contrast sonography ( HyCoSy ) with an echocontrast agent and transvaginal ultrasonography alone in the evaluation of tubal status . Methods : Thirty patients were included in the study . These patients underwent an initial plain transvaginal ultrasound examination the day before the HyCoSy . The findings obtained from both examinations were compared with laparoscopic diagnosis , performed in the same menstrual cycle . Results : The kappa values were 0.48 for patency evaluation and 0.67 for the diagnosis of the presence of at least one patent tube , suggesting a good agreement in both cases between HyCoSy and surgery . HyCoSy had a significantly lower sensitivity ( 50 % ) , but not a significantly higher specificity ( 75 % ) , than transvaginal ultrasonography alone in the diagnosis of tubal infertility-related abnormalities such as peritubal adhesions . Conclusions : The study demonstrates that the HyCoSy is a useful test when scheduling the most suitable treatment for infertile couples OBJECTIVE To evaluate the pain and cause of pain experienced by women undergoing hysterosalpingography ( HSG ) and contrast hysterosalpingo sonography ( HyCoSy ) with air in a saline solution for the assessment of uterine and tubal patency . METHOD In this prospect i ve study , 121 infertile women undergoing these 2 procedures measured the pain incurred using a digital/analog scale ( 1 - 10 ) . We looked for correlations between pain level and variables pertaining to the procedures . Vagal effects and their persistence were also recorded . RESULTS The pain was less during HSG ( median , 5 ) than during HyCoSy ( median , 7 ) . It was greater than menstrual pain for 38.8 % of participants during HSG and for 70.5 % of participants during HyCoSy . There was no correlation between pain and difficult catheter passage , degree of tubal obstruction , volume of contrast medium injected , or presence of IgG antibodies to Chlamydia when these variables were studied for HyCoSy alone . However , the strong correlation between pain score and volume of contrast medium injected during each procedure seems to explain the significantly higher pain levels during HyCoSy ( P<0.001 ) . In 65.3 % and 57.8 % of participants , respectively , the pain disappeared immediately after the HSG or HyCoSy . Only mild vagal effects were recorded following both procedures , in 0.8 % of participants after HSG and 2.5 % of participants after HyCoSy . CONCLUSION Hysterosalpingo contrast sonography is similar to HSG regarding rapidity of pain disappearance , and infrequency and moderation of vagal effects , but the level of pain is slightly higher , probably due to the greater volume of medium injected In this study , we compare the prognostic significance of hysterosalpingography ( HSG ) and laparoscopy for fertility outcome . In a prospect i ve cohort study in 11 clinics participating in the Canadian Infertility Treatment Evaluation Study ( CITES ) , consecutive couples who registered between 1 April 1984 and 31 March 1987 for the evaluation of subfertility and who underwent HSG and laparoscopy were included . Unilateral and bilateral tubal occlusion at HSG and laparoscopy were related to treatment-independent pregnancy . Cox regression was used to calculate fecundity rate ratios ( FRR ) . Of the 794 patients who were included , 114 ( 14 % ) showed one-sided tubal occlusion and 194 ( 24 % ) showed two-sided tubal occlusion on HSG . At laparoscopy , 94 ( 12 % ) showed one-sided tubal occlusion and 96 ( 12 % ) showed two-sided tubal occlusion . Occlusion detected on HSG and laparoscopy showed a moderate agreement beyond chance ( weighted kappa-statistic 0.42 ) . The adjusted FRR of one-sided tubal occlusion at HSG was 0.80 , whereas two-sided tubal occlusion showed an FRR of 0.49 . For laparoscopy , the FRR were 0.51 and 0.15 respectively . After a normal or one-sided occluded HSG , laparoscopy showed two-sided occlusion in 5 % of the patients , and fertility prospect s in these patients were virtually zero . If two-sided tubal occlusion was detected on HSG but not during laparoscopy , fertility prospect s were slightly impaired . Fertility prospect s after a two-sided occluded HSG were strongly impaired in cases where laparoscopy showed one-sided and two-sided occlusion , with FRR of 0.38 and 0.19 respectively . Although laparoscopy performed better than HSG as a predictor of future fertility , it should not be considered as the perfect test in the diagnosis of tubal pathology . For clinical practice , laparoscopy can be delayed after normal HSG for at least 10 months , since the probability that laparoscopy will show tubal occlusion after a normal HSG is very low OBJECTIVE To demonstrate the diagnostic efficacy of 2D B-mode , color and pulsed Doppler Hy-Co-Sy and 3D B-mode and power Doppler Hy-Co-Sy . STUDY DESIGN AND METHODS One hundred and fifty-two women were recruited into the 2D B-mode , color and pulsed Doppler Hy-Co-Sy study and 116 other women were recruited into the 3D B-mode and power Doppler Hy-Co-Sy study .  We assessed the diagnostic performance ( sensitivity , specificity , PPV and NPV ) of 2D and 3D Hy-Co-Sy , compared to hysteroscopy , and laparoscopy and dye test in the assessment of uterine abnormalities and tubal patency , respectively . RESULTS The sensitivity , specificity , PPV and NPV of 2D hysterosonography compared to hysteroscopy were 93.6 , 97.3 , 98.2 and 97.3 % , respectively . The sensitivity , specificity , PPV and NPV of 3D hysterosonography  compared to hysteroscopy were 97.9 , 100 , 97.9 and 100 % , respectively . Addition of color and pulsed Doppler to 2D Hy-Co-Sy and power Doppler to 3D Hy-Co-Sy contributed to diagnostic precision in detection of tubal patency . The sensitivity , specificity , PPV and NPV of 3D power Doppler Hy-Co-Sy in detection of tubal patency compared to laparoscopy and dye intubation were 100 , 99.1 , 99.2 and 100 % , respectively . CONCLUSION 2D and 3D Hy-Co-Sy are accurate methods for evaluation of uterine abnormalities and tubal patency in infertile patients BACKGROUND Hysterosonosalpingography as a contrast ultrasound method is safer , cheaper and easier to perform than hysterosalpingography in the assessment of the uterine cavity and fallopian tubes . Is it feasible for all patients ? Which is the main problem in the evaluation of target structures by ultrasound ? METHODS In a prospect i ve study , 68 patients in the initial stage of the infertility treatment were examined by hysterosonosalpingography using saline NaCl infundibile and Echovist as contrast media . Subsequently , further status of the tubes and uterine cavity was assessed by the " gold st and ards " , laparoscopy and hysteroscopy . RESULTS Sensitivity and specificity of hysterosonosalpingography using NaCl infundibile for evaluation of the uterine cavity was 100 and 88.8 % , respectively . Negative predictive value was 100 % and positive predictive value 97 % . Sensitivity and specificity of the method for the assessment of the tubal status was 100 and 66 % , respectively , negative predictive value was 100 % and positive predictive value was 61 % . For the assessment of tubal patency using positive contrast Echovist the method has shown 100 % sensibility and negative predictive value again but it reached a specificity of 77 % and a positive predictive value of 70 % . There were no evident complications during or after the procedure . CONCLUSION Hysterosonosalpingography is useful in making decisions regarding further procedures for the diagnosis and treatment of infertility . Uterine cavity evaluation using saline is the method of choice . Tubal patency can be assessed only under ideal sonographic conditions . The method is feasible for early assessment of the reproductive status of uterine cavity and fallopian tubes as a simple , safe and cheap outpatient method prior to any following invasive procedure or even histerosalpingography Background Hysterosalpingosonography has been suggested as a less invasive alternative to hysterosalpingography for detecting tubal occlusion among subfertile women . We aim to determine the diagnostic accuracy of hysterosalpingosonography and to compare it to hysterosalpingography . Methods / design We will conduct a systematic review of diagnostic test accuracy . We will search Medline , Embase , Cochrane Library , Web of Science and Biosis , as well as reference lists of included studies and previous related review articles . Diagnostic studies that compared hysterosalpingosonography ± hysterosalpingography to laparoscopy with chromotubation in women suffering from subfertility will be eligible . Two authors will independently screen for inclusion , data extraction , and quality assessment . Method ological quality will be assessed using the Quality Assessment of Diagnostic Accuracy Study 2 tool ( QUADAS-2 ) . We will use SAS 9.3 ( SAS Institute Inc. , Cary , NC , USA , 2011 ) to program bivariate r and om-effects models , estimate pooled sensitivity and specificity with 95 % confidence intervals and to generate summary receiver operating characteristics curves . We will perform sensitivity analyses to examine the effect of differences in techniques used for hysterosalpingosonography and in method ological quality of studies . Discussion This systematic review will help to determine if hysterosalpingosonography is an adequate alternative screening test for diagnosing tubal occlusion . Accuracy of specific sono-HSG techniques may also be identified . Systematic review registration This review has been registered at PROSPERO . The registration number is OBJECTIVE To evaluate the side effects and complications of , difficulties with , and possible solutions to the problems associated with sonohysterosalpingography . DESIGN Prospect i ve study . SETTING University hospital . PATIENT(S ) One thous and , one hundred fifty-three patients who underwent sonohysterosalpingography to investigate abnormal uterine bleeding , infertility , thick endometrium at transvaginal ultrasonography , müllerian abnormalities , or the Asherman syndrome . MAIN OUTCOME MEASURE(S ) Side effects and complications of and difficulties related to the procedure . Tolerance was assessed by using a pain-rating scale . RESULT ( S ) Ninety-three percent ( 1,074 of 1,153 ) procedures were performed correctly . Investigation was not completed in 79 ( 7 % ) women ; a second attempt was successful in 60 of these patients . Side effects , such as moderate or severe pelvic pain , vasovagal symptoms , nausea , and vomiting , occurred in 102 ( 8.8 % ) women . Such complications as fever and peritonitis occurred in 0.95 % of patients . CONCLUSION ( S ) Sonohysterosalpingography is a simple , safe , and well-tolerated technique that has a low rate of side effects and rare complications OBJECTIVE To assess tubal patency by color Doppler hysterosalpingography ( HSG ) . DESIGN Comparative study of color Doppler HSG with roentgenogram HSG and chromolaparoscopy in infertile women of childbearing age . SETTING Clinical environment . PATIENTS Sixty female patients ( 22 to 39 years ) with long-lasting infertility problems . INTERVENTION Sterile saline was transcervically injected into the uterine cavity through a catheter and color Doppler HSG was performed . All the patients were su bmi tted to roentgenogram HSG and chromolaparoscopy . MAIN OUTCOME MEASURES The diagnostic efficacy of color Doppler HSG and its concordance with " gold st and ard " chromolaparoscopy were analyzed . RESULTS Correlation between color Doppler HSG and roentgenogram HSG with chromolaparoscopy occurred in 86 % versus 93 % of all women studied . CONCLUSIONS Color Doppler HSG with its accuracy and safety results a promising alternative technique to roentgenogram HSG in diagnosing tubal status in infertile patients OBJECTIVES To compare the use a simplified ultrasound based infertility investigation of the infertile couple with the current use of laparoscopy and hysteroscopy . STUDY DESIGN Thirty-three infertile couples underwent transvaginal ultrasound and hystero-salpingo-contrast-sonography .  A diagnosis was formulated based on the results of the ultrasound investigations , a semen analysis and endocrine parameters . The following day , all subjects underwent a laparoscopic chromotubation and hysteroscopy by a surgeon unaware of the ultrasound findings . A diagnosis based on the findings at laparoscopy and hysteroscopy , the same semen analysis and endocrine parameters , was then made . The two diagnoses were compared . RESULTS A 90.9 % agreement was found between the diagnoses made from the two methods used . When considering laparoscopic diagnosis the Gold St and ard of tubal patency , the 
    Output:
    
SUMMARY ANSWER sono-HSG is an accurate test for diagnosing tubal occlusion and performs similarly to HSG .
We also found no benefit of the commercially available contrast media over saline solution in regard to the diagnostic accuracy of sono-HSG .
WIDER IMPLICATION S OF THE FINDINGS Given our findings and the known benefits of sono-HSG over HSG in the context of subfertility , sono-HSG should replace HSG in the initial workup of subfertile couples .