EVALUATION OF THE PERFORMANCE OF HYSTEROSALPINGO CONTRAST SONOGRAPHY IN 500 CONSECUTIVE, UNSELECTED, INFERTILE WOMEN

The performance of hysterosalpingo contrast sonography (Hy Co Sy) as a first-line, outpatient investigation of tubal patency was examined in 500 consecutive, infertile women, at one centre. Hy Co Sy was complet ed in 463 (92.6%) cases, using a galactose microbubble contrast agent (Echovist(R)-200) and transvaginal sonography. Initial plain scanning identified adnexal pathology in 198 women (39.6%), Examination with Ec hovist was attempted for 905 tubes and only 67 (7.4%) were not assessa ble; after the first 100 women this decreased to 35 tubes (4.8%). A so nographic appearance compatible with blocked tubes was found on 118 (1 4.1%) occasions but it was also possible to identify variations in the appearance/filling/spilling patterns of individual tubes which increa sed the number assessed as abnormal to 193 (23.0%). Comparison with la paroscopy and dye chromopertubation findings from the past three years was possible for 185 (37%) women, representing 282 tubes, which gave Hy Co Sy an overall concordance rate of 85.8%, sensitivity of 90.4%, s pecificity of 70.3%, positive predictive value of 91.2% and negative p redictive value of 68.2%, Some 51.0% of women described only mild disc omfort and there were no significant postprocedure complications. Hy C o Sy appears to be an acceptable first-line screen and may select out women in whom more invasive investigations are likely to reveal pathol ogy.