Changing the Algorithm in the Evaluation of Pelvic Anatomy in the Infertile Patient: Is Hysterosalpingo Contrast Sonography With Saline-Air Device the Appropriate Test for Everyone?
The evaluation of the fallopian tubes is an essential part of the infertility workup, with
abnormalities related to the fallopian tubes accounting for up to 40% of female subfertility.
Laparoscopy is still considered the gold standard in the diagnostic evaluation of fallopian tubes,
though the hysterosalpingogram (HSG) has long been recognized as complementary to laparoscopy, since tubal anatomy can be distinctly be seen.
That said, previous investigations using laparoscopy as the gold standard demonstrate HSG has a sensitivity and specificity of 53% and 87%, respectively, for any tubal pathology and 46% and 95%, respectively, for bilateral tubal
In last few years, there has been a move away from these methods and towards the
use of Hysterosalpingo Contrast Sonography (HyCoSy).
Laparoscopy mandates regional or general anesthesia and incurs significant operative costs and risks.
In contrast, while HSG obviates the need for hysteroscopy and/or laparoscopy,
it is associated with exposure to ionizing radiation and the need for iodinated contrast material.
While HyCoSy has been advocated as an alternative to the HSG since the 1980s, its use in evaluating tubal patency has been limited as the normal fallopian tube is a poor sonic reflector, devoid of the defined interfaces that produce
clear organ outlines.
Various agents to enhance transvaginal ultrasound visualization of the
fallopian tubes have been described; however, given storage issues, expense, and lack of FDA
approval, it has obviated their routine use in the office setting.
Gynecol Obstet Res Open J. 2016; 2(5): 126-128. doi: 10.17140/GOROJ-2-126