Review Article

Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup

Table 1

A summary of the studies used, grouped per reference and subject, mentioning the type of the study, the study design, and the main results.

Subject/ReferenceType of studyStudy designMain results

accuracy

[15] Emanuel et al. 2012ObservationalFirst observational study (n=73)Successful procedure 92%

[16] Van Schoubroeck et al. 2013ObservationalHyFoSy versus Laparoscopy (n=20)Agreement 100%

[17] Lim et al. 2015RCTHyFoSy versus saline HyCoSy (n=40)HyFoSy performed better

[18] Piccioni et al. 2017RCTLSC controlled trial HyFoSy versus HyCoSy (n=37)HyFoSy 94,4% versus HyCoSy 57,8%

[19] Ludwin et al. 2017ObservationalLSC controlled trial HyFoSy versus HyFoSy Doppler and saline HyCoSy (n=132)HyFoSy (92,1%) and HyFoSy Doppler (95,8%) performed better than saline HyCoSy (84,2%)

3D US and Doppler flow techn.

[21] Soliman et al. 2015ObservationalLSC versus saline HyCoSy Power Doppler flow mappingPower Doppler saline HyCoSy can be incorporated in routine fertility workup

[22] Exacoustos et al. 2017Observational2D HyFoSy compared to automated 3D CCI HyFoSy (n=132)3D CCI HyFoSy is accurate and safe

[23] Riganelli et al. 2018RCTLSC controlled 2D HyFoSy versus 3D HyFoSy (n=50)3D HyFoSy performed better (88% versus 81%)

[24] Ludwin et al. 2017ObservationalRetrospective 2D Doppler HyFoSy versus 2D HyCoSy2D Doppler HyFoSy performed better

[26] Lavaillant et al. 2019ObservationalFertiliscan© including 3D HyFoSyAnatomy of uterus, ovaries and tubes

Discomfort and pain

[27] Savelli et al. 2009ObservationalHyCoSy with paediatric balloon catheter (n=483)Pain: no (30,0%), mild (49,7%) and severe (6,8%)

[28] Tur-Kaspa 2012OpinionExpert opinion and reviewEducation in gentle technique
[29] Dreyer et al 2014RCTVAS score HyFoSy versus HSG (n=40)Lower VAS score for HyFoSy (1.7 vs 3.7; p<0.01)

[30] Van Schoubroeck et al. 2015Cross sectionalVAS score TVU and TVU + subsequent HyFoSy (n=216)Lower VAS score for TVU (1.5 vs 3.6)

[31] Van Schoubroeck et al. 2015Randomized trialVAS score HyFoSy with paediatric Foley’s catheter versus uVue catheter (n=40)Foley’s catheter easier to insert
uVue catheter less painful

[32] Ludwin et al. 2017ObservationalHyFoSy with and without analgesics (n=300)VAS score higher without analgesics (3.0 vs 2.0; p=0.002)

catheter

[33] Yung et al 2016RTCWithout balloon versus with balloon (n=120)Without balloon less pain

[34] Dessole et al 2001ObservationalComparison of 6 different catheters (n=568)No difference observed

temperature

[35] Fenzl 2012ObservationalSaline and Echovist temp 250 versus 370 (n=138)Less pain in case of body temperature

[36] Opolskiene et al. 2015ObservationalSaline (SIS) in premenopausal versus postmenopausal women (n=99)Postmenopausal more pain (71% vs 32%; p<0.002)

[37] Zhu et al. 2012ObservationalHSG room versus body temperature contrast (n=200)Less pain with warm contrast

analgesics

[38] Frishman et al. 2004RCTlidocaine or saline before HSG (n=127)No differences in pain score

[39] Guney et al 2007RCTLocal lidocaine before SIS (n=106)Only beneficial in parous women

[40] Van den Bosch et al. 2011ObservationalLocal lidocaine before Hysteroscopy (n=132)No difference

[33] Yung et al. 2016RCTSIS with and without lidocaine (n=120)No difference

[41] Hindocha et al. 2015Systematic reviewPain relief in HSGLocal analgesics may be effective

[42] Ahmad et al. 2007Systematic reviewAny analgesia in HSGNo benefit

[43] Ahmad et al. 2011Systematic reviewAny analgesia in HyCoSyNo benefit

[44] Moro et al 2012RTCAntispasmodic drug in HyCoSy (n=816)No difference in pain scores

[45] Teran-Alonso et al. 2014ObservationalParacetamol and ibuprofen prior to hysteroscopyNo reduction of pain scores

[46] Karaman et al. 2016RTCRectal indomethacin prior to HSGEffective in pain reduction

Intravasation

[47] Onwuchekwa and Oriji 2017ObservationalHSG with WSCM (n=299)Intravasation in 6.4%

[48] Wang et al. 2018ObservationalIntravasation in HyCoSy with SonoVue (n=276)Intravasation in 13.04%

[49] Ludwin et al. 2018Case reportFirst report on intravasation with HyFoSy

PID prevention

[51] Dessole et al. 2003ObservationalSonohysterosalpingography (n=1.153)Fever and peritonitis in 0.95%

[52] Pittaway et al. 1983ObservationalPID after HSG in tubal occlusion 4/35 (11%) without and 0/56 (0%) with antibioticsAntibiotics only in case of tubal occlusion

[53] Simms et al. 2006Case control studyRisk factors associated with PID in 140 cases compared to 105 controlsAge <25, early first sex experience, low socio-economic status and chlamydia exposure

[54] Kasius et al. 2011RCTAB prophylaxis for hysteroscopy (n=266 AB vs 365 contr)PID in AB 0.4% versus contr 0%

[55] Gregoriou et al. 2012RCTAB prophylaxis for hysteroscopy (n=364 AB vs 188 contr)PID in AB 0.57% versus contr 0.53%

[56] Nappi et al. 2013RCTAB prophylaxis for hysteroscopy (n=523 AB vs 523 contr)PID in AB 1.0% versus contr 1.15%; p>0.05

[57] Thinkamrop et al. 2013Cochrane Syst RevAB prophylaxis for transcervical intrauterine proceduresNo conclusion possible

[58] Pareira et al. 2016Systematic reviewAB prophylaxis for Gynaecologic procedures.Not as routine, only in high risk cases

Enhancing chance of pregnancy

[59] Van Schoubroeck et al. 2015ObservationalRetrospective study 3-42 months after HyFoSy (n=359)Pregnancy rate 55%

[14] Tanaka et al. 2018ObservationalRetrospective cohort study 6 months after HyFoSy (n=111)Pregnancy rate 43%

[15] Emanuel et al. 2012ObservationalRetrospective study 3 months after HyFoSy (n=73)Pregnancy rate 19.2%

[60] Exacoustos et al. 2015ObservationalRetrospective study 1, 6 and 12 months after HyFoSy (n=157)Pregnancy rates 10.2%, 29.6% and 34.4%

[61] Watson et al. 1994Meta analysis4 RTCs and 6 others on HSG with OSCM versus WSCMTherapeutic effect of OSCM

[62] Johnson et al. 2005Cochrane Syst RevSystematic Review OSCM and OCSM versus WSCMTherapeutic effect of OSCM

[63] Johnson 2014Narrative reviewOSCM treatment of infertilityTherapeutic effect in endometriosis

[64] Mohiyiddeen et al. 2015Cochrane Syst RevThe effect of tubal flushing on life birth and pregnancy ratesHigher life birth rate for OSCM versus WSCM (OR 3.09 versus 1.38)

[65] Dreyer et al. 2017Multicentre RCTPregnancy 6 months after OSCM versus WSCM (n=1119)Higher pregnancy rate after OSCM (39% vs 29%)

[70] Lindborg et al. 2009RCTHyCoSy with WSCM (n=334)No enhanced pregnancy rate

[71] Giugliano et al 2012ObservationalSaline HyCoSy (n=180)45% pregnancy rate in the first 30 days

[73] Ahinko-Hakamaa et al. 2007ObservationalPregnancy rates after (mean) 2.3 cycles with IUI.Pregnancy rates after LSC 30%, HyCoSy 41% and HSG 38%.

[74] Dreyer et al. 2019Post-hoc analysisProspective multicentre cohort study (n= 4556)HSG increased pregnancy rate compared to no HSG regardless of WSCM or OSCM

[75] Chunyan et al. 2018ObservationalPregnancy within 180 days after HyCoSy (n=1008)Higher pregnancy rates if both tubes are open

[77] Salehpour et al. 2016RCTSaline infusion prior to IVF (n=20) versus controls (n=39)Pregnancy 1/20 versus 9/39 (p=0.01)

[78] Reilly et al. 2019RCTOSCM endometrial bathing prior to IVF (n=33) vs controls (n=37) in women with endometriosisPregnancy within 6 months 11/33 (33%) versus 12/37 (32%)