US Sonohysterography with Tubal Contrast Agent HyCoSy involves instilling echogenic contrast, typically an agitated air and saline mixture, into the uterus with real- time US to observe the material distending the uterine cavity, filling the fallopian tubes, and spilling out over the adjacent ovary [53]. HyCoSy is similar to HSG when compared with laparoscopy with chromopertubation in determining tubal patency [54]. It has been proposed that TVUS with 3-D imaging of the uterus and ovaries followed by SIS and HyCoSy with agitated saline can be performed in one session as a comprehensive infertility examination [42]. HyCoSy has been shown to be 91% accurate compared with laparoscopy in diagnosing tubal patency in women with endometriosis [55]. Hysterosalpingo-foam sonography in combination with 2-D or 3-D imaging has demonstrated improved accuracy of 93.7% and better concordance with laparoscopy compared with 2-D or 3-D air or saline HyCoSy [65,66] for assessment of tubal patency. The addition of high-definition flow (bidirectional Doppler feature) achieved even higher accuracy at 96.9%, comparable with the reference method of laparoscopic chromopertubation with dye [65]. However, high-definition flow still needs to be validated by other groups. Variant 5: Female infertility. Recurrent pregnancy loss. Initial imaging. Fluoroscopy Hysterosalpingography In 24 cases of surgically proven MDA, MRI was 100% accurate, 2-D TVUS was 92% accurate, and hysterosalpingogram was only 16.7% accurate in characterizing MDAs [67]. Although HSG can visualize the uterine cavity, it cannot always provide complete information about the external uterine contour, preventing accurate distinction between a septate and a bicornuate uterus. A study of 54 women with suspected Asherman syndrome discovered 3-D US was 100% sensitive, and HSG was 66.7% sensitive in grading intrauterine adhesions compared with hysteroscopy [68].
Female Infertility. US Sonohysterography with Tubal Contrast Agent HyCoSy involves instilling echogenic contrast, typically an agitated air and saline mixture, into the uterus with real- time US to observe the material distending the uterine cavity, filling the fallopian tubes, and spilling out over the adjacent ovary [53]. HyCoSy is similar to HSG when compared with laparoscopy with chromopertubation in determining tubal patency [54]. It has been proposed that TVUS with 3-D imaging of the uterus and ovaries followed by SIS and HyCoSy with agitated saline can be performed in one session as a comprehensive infertility examination [42]. HyCoSy has been shown to be 91% accurate compared with laparoscopy in diagnosing tubal patency in women with endometriosis [55]. Hysterosalpingo-foam sonography in combination with 2-D or 3-D imaging has demonstrated improved accuracy of 93.7% and better concordance with laparoscopy compared with 2-D or 3-D air or saline HyCoSy [65,66] for assessment of tubal patency. The addition of high-definition flow (bidirectional Doppler feature) achieved even higher accuracy at 96.9%, comparable with the reference method of laparoscopic chromopertubation with dye [65]. However, high-definition flow still needs to be validated by other groups. Variant 5: Female infertility. Recurrent pregnancy loss. Initial imaging. Fluoroscopy Hysterosalpingography In 24 cases of surgically proven MDA, MRI was 100% accurate, 2-D TVUS was 92% accurate, and hysterosalpingogram was only 16.7% accurate in characterizing MDAs [67]. Although HSG can visualize the uterine cavity, it cannot always provide complete information about the external uterine contour, preventing accurate distinction between a septate and a bicornuate uterus. A study of 54 women with suspected Asherman syndrome discovered 3-D US was 100% sensitive, and HSG was 66.7% sensitive in grading intrauterine adhesions compared with hysteroscopy [68].