US Sonohysterography with Tubal Contrast Agent Hysterosalpingo-contrast sonography (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]. Accuracy of HyCoSy is similar to HSG when compared with laparoscopy with chromopertubation in determining tubal patency with sensitivity of 75% to 96% and specificity of 67% to 100% when compared directly with laparoscopy with chromopertubation [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]. In women with endometriosis, HyCoSy has been shown to be 91% accurate compared with laparoscopy in diagnosing tubal patency [55]. This modality can also detect endometriomas as well as pelvic adhesive disease and endometriotic nodules, especially in the hands of well-trained operators. Variant 4: Female infertility. Suspicion of tubal occlusion. Initial imaging. Fluoroscopy Hysterosalpingography HSG allows detection of tubal patency, tubal size, tubal irregularity, and peritubal disease. It can also detect intrauterine synechiae, which typically present as irregular endometrial filling defects [11]. Tubal flushing during HSG has also been shown to increase pregnancy rates up to 38% compared with pregnancy rates of up to 21% in women being investigated for infertility who did not undergo HSG. Pregnancy rate in this study was highest in women who underwent HSG with oil-soluble contrast [56]. However, unlike performance of HSG with water- soluble contrast agents, the use of oil-based contrast material for HSG carries the increased risk of oil emboli if there is myometrial intravasation [57].
Female Infertility. US Sonohysterography with Tubal Contrast Agent Hysterosalpingo-contrast sonography (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]. Accuracy of HyCoSy is similar to HSG when compared with laparoscopy with chromopertubation in determining tubal patency with sensitivity of 75% to 96% and specificity of 67% to 100% when compared directly with laparoscopy with chromopertubation [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]. In women with endometriosis, HyCoSy has been shown to be 91% accurate compared with laparoscopy in diagnosing tubal patency [55]. This modality can also detect endometriomas as well as pelvic adhesive disease and endometriotic nodules, especially in the hands of well-trained operators. Variant 4: Female infertility. Suspicion of tubal occlusion. Initial imaging. Fluoroscopy Hysterosalpingography HSG allows detection of tubal patency, tubal size, tubal irregularity, and peritubal disease. It can also detect intrauterine synechiae, which typically present as irregular endometrial filling defects [11]. Tubal flushing during HSG has also been shown to increase pregnancy rates up to 38% compared with pregnancy rates of up to 21% in women being investigated for infertility who did not undergo HSG. Pregnancy rate in this study was highest in women who underwent HSG with oil-soluble contrast [56]. However, unlike performance of HSG with water- soluble contrast agents, the use of oil-based contrast material for HSG carries the increased risk of oil emboli if there is myometrial intravasation [57].