Air Contrast Sono-HysteroSalpingography Versus Hysterosalpingography for Tubal Evaluation in Subfertility

Objective: To compare the diagnostic accuracy of sono-hysterosalpingography (HyCoSy) using gaseous spring water for tubal patency with hysterosalpingography (HSG) in sub fertile women. Methodology:  A cross-sectional study was conducted from June to December 2022 at the Maternal and Child Health Center and Radiology Department of PIMS, Islamabad This study included subfertile women of reproductive age presenting in infertility clinic. Pregnant women, those with male factor subfertility, per vaginal bleeding at time of procedure, active pelvic infection or history of unprotected intercourse in current cycle were excluded. Tubal evaluation done in late follicular phase of menstrual cycle, immediately after menstruation cessation in the outpatients of MCHC by HyCoSy using gaseous spring water at transvaginal ultrasound (TVS). Hysterosalpingography was done in all these women in radiology department using oil based iodinated contrast. Results: Among 65 studied women with subfertility, 23 (35.4%) had primary subfertility while 42 (64.6%) had secondary subfertility. Mean age was 32.25 years. The average duration of subfertility was 5.09 years. HSG showed 40 (58.4%) had Patent tubes while with HyCoSy patent tubes were reported in 43 (66.1%). HSG and HyCoSy had unilateral non visualization of fallopian tubes in 4 (5.3%) and 3 (4.6%) cases respectively. No hydrosalpinx was noted in the two tests.  The positive predictive value for diagnosis of tubal patency for HyCoSy versus HSG was 86.41%. The negative predictive value for diagnostic accuracy of HyCoSy was 90.41%. Conclusion: HSG and HyCoSy were complementary to each other for tubal evaluation in subfertility. HyCoSy showed high positive and negative predictive value compared to HSG.