P-334 Hysterosalpingo-Contrast-Sonography: a key step in the female infertility workup?
Authors: Chaala R  Y , Chanegriha M , Yendjah F , Atmani A , Bellala B , Rabhi N , Atir M , Hassani S , Mouhoub S 
Published: July 2024

Abstract

Study question
The main objective of this study is to estimate the possibility of offering Hystero-Salpingo-Contrast-Sonography (HyCoSy) as a first-line diagnosis test in the female infertility exploration

Summary answer
HyCoSy represents a key step in decision-making regarding subsequent steps in infertility diagnosis and treatment

What is known already
In this age of rising rates of infertility; the evaluation of the fallopian tubes and the endometrial cavity in an essential part of the infertility investigation.
Traditionally hysterosalpingography has been used to evaluate tubal patency; but it has many disadvantages; laparoscopy and hysteroscopy are at present considered as the gold standard techniques for tubal and endometrial cavity assessment, respectively. Hysterosalpingo- Contrast –Sonography or HyCoSy was introduced over 20 years ago since 1981; it allows to gynecologist to evaluate the fallopian tubes the uterus and the ovaries with only one ultrasound in the office.

Study design, size, duration
During two years, one hundred and sixty-seven patients with a context of female infertility with normal spermogram were included in our prospective and descriptive study,

Participants/materials, setting, methods
Our patients underwent: a Hysterosalpingography (HSG), a Hysteroscopy, a Laparoscopy and as part of our study: a Hystero-Salpingo-Contrast-Sonography (HyCoSy), a comparison was made between the tubal and uterine parameters found by the HyCoSy with those of the HSG after comparison with the data shown by the Gold Standard techniques: Laparoscopy and Hysteroscopy, also we evaluated the failure rate, its duration, its tolerability, its cost, its complications, its limitations and the rate of post-HyCoSy pregnancies.

Main results and the role of chance
The technique was impossible in 4 patients, so a failure rate of 2.4%, the average duration of the procedure was 17+/-1 min (10-30 min), generally well tolerated, pain assessment found an average of 3 on the VAS (2-4), the rate of all minor complications was 8.85% at 5 min and 3.06% at 15 min, no case of allergy to the contrast product was noted.
Following the 4 cases of failures the comparison was only possible in 163 patients, after comparing the data with the GOLD STANDARDS
For the tubal permeability we noted almost perfect concordances between the three techniques HyCoSy, HSG and laparoscopy, with a concordance of 0.87 between HyCoSy versus laparoscopy (p value at 0.34) and 0.85 between HSG versus laparoscopy (p value at 0.18),
For the uterine cavity evaluation the comparison of hydrosonography(step one of our technique) to hysteroscopy finds an almost perfect agreement at 0.88 (p value at 0.71) in contrast to a low agreement at 0.27 between the HSG and the gold standard (p value &lt;0.02).
Our technique also allows us to carry out a morphological and functional assessment of the ovaries as well as a study of the peritoneal cavity.

Limitations, reasons for caution
A disadvantage of this technique is the rate of false results, regardless of the contrast product used. However, it is important to note that these errors also occur when using an HSG, or during a Laparoscopy.A review of the literature allows us to identify the causes and identify solutions.

Wider implications of the findings
It is important to work more on improving exploration techniques by working to ensure that they are as precise, tolerable, of certain safety and as economical as possible and why not with a therapeutic effect.

Trial registration number
not applicable