Diagnostic performance of HyFoSy versus HSG for tubal patency: accuracy and agreement analysis

Purpose Tubal patency examination is an essential part of the infertility workup; HyFoSy is a recommended substitute for the standard Hystero-Salpingo Graphy (HSG). This study aims to determine the diagnostic concordance of HyFoSy and HSG and to determine impact of uterus position on test performance. Material and methods A prospective observational cohort study enrolled 80 infertile women referred for assessing tubal patency at Al Yarmouk Hospital.Parameters recorded: demographics ( age, parity, uterus position) and tubal patency test interpreted ( patent, unilateral, or bilateral blocked tubes). HyFoSy was performed first, followed by HSG. Results Age and parity were insignificant. HyFoSy showed a high degree of diagnostic concordance with HSG ( 85%) with 0.3 (95% CI: 0.05–0.55) Cohen's kappa coefficient . Gwet's AC1 coefficient was 0.84 (95% CI: 0.74–0.94), indicating strong agreement. McNemar's test revealed significant systematic bias between the methods (P < 0.001), suggesting that HyFoSy and HSG are not interchangeable, which was further confirmed by Bland-Altman analysis showing a mean bias of +0.25 in favor of HyFoSy.The latter has a tendency to overestimate tubal patency among women with a retroverted uterus. Conclusions HyFoSy is a promising tool to be used as a complementary infertility test showing high concordance with HSG. However, it should not be used as a stand-in for HSG without clinical judgment, especially in women with a retroverted uterus. The best of both approaches may be provided by a hybrid strategy that uses HyFoSy as a first-line test and saves HSG for cases that are unclear or high-risk.