The assessment of endometrial pathology and tubal patency: a comparison between the use of ultrasonography and X-ray hysterosalpingography for the investigation of infertility patients

Objectives The aim of the present study was to examine the role of hysteros alpingocontrast sonography (HyCoSy) as a screening test for endometrial and tubal Pathology at the start of the infertility investigation protocol. Methods HyCoSy was compared with X-ray hysterosalpingography (HSG) for the assessment of the endometrial cavity and Fallopian tube patency. A total of 103 women with a history of at least 1 year's infertility were included. E ach woman underwent both HyCoSy and HSG on the same day. Laparoscopy was pe rformed in 43 cases. For HyCoSy examinations, saline was used for evaluatio n of the endometrial cavity and Echovist(R) contrast medium to assess Fallo pian tube patency. Results The concordance between HyCoSy and HSG for the presence of endometr ial cavity pathology was 90%, but for tubal patency the concordance was low er (72%). HyCoSy classed more examinations of tubal patency as uncertain. H SG more frequently classified tubes as occluded. In the subset of patients in whom all three techniques were used, HSG and HyCoSy demonstrated a high concordance with laparoscopy (83% and 80%, respectively). The prevalence of occluded tubes according to laparoscopy as the reference standard was 13%. The two methods had a high negative predictive value for tubal disease (HS G, 94%; HyCoSy, 88%), and the positive predictive values were 47% and 75%, respectively. The detection rate for occluded tubes was 73% and 27%, and sp ecificity 87% and 90%, respectively. Conclusions Our data demonstrate that HyCoSy obtains similar information ab out the status of the endometrial cavity and Fallopian tube patency to that of HSG. It is possible that in some cases HyCoSy may replace HSG in order to select women with patent tubes who may be suitable for further infertili ty treatment without more invasive investigation.