A comparison of hysterosalpingo-foam sonography (HyFoSy) and hysterosalpingo-contrast sonography with saline medium (HyCoSy) in the assessment of tubal patency

ObjectiveA randomized controlled selective cross-over trial was performed to compare the diagnostic yield and efficacy of ExEm foam (HyFoSy) with saline medium (HyCoSy) as a contrast agent for hysterosalping-contrast sonography in subfertile patients.Study design40 patients were randomized into HyCoSy with saline medium and HyFoSy with ExEm foam. Tubal patency were assessed according to pre-determined objective criteria that classified tubes based on degree of certainty in tubal patency. Selective cross-over testing with the other medium was performed in patients who had at least one possibly occluded or unexaminable tube on the initial test.Results80 tubes were evaluated. On initial testing, the proportion of tubes that were classified as patent was higher with HyFoSy compared to HyCoSy (70.0% vs 40.0%, p = 0.01). A higher proportion of patients in the HyCoSy group required crossover testing [80.0% (16/20) vs 45.0% (9/20), p = 0.02]. On cross-over testing, 41.7% (10/24) of possibly occluded or unexaminable tubes in the HyCoSy group were re-classified as patent when examined with Ex-Em foam, compared to 8.3% (1/12) of possibly occluded or unexaminable tubes in the HyFoSy group (p = 0.03).ConclusionExEm foam medium (HyFoSy) might improve the diagnostic yield and efficacy over saline medium (HyCoSy) for hysterosalpingsonography.