Intravasation complicating hysterosalpingo-foam sonography (HyFoSy) using ExEm® Foam.

Uterine and tubal patency assessments are critical in diagnosing subfertility. Traditional hysterosalpingography (HSG) involves radiation exposure and can cause intravasation of contrast agents. Transvaginal hysterosalpingo-foam sonography (HyFoSy) offers an alternative with no ionizing radiation. However, the risk of intravasation remains a concern. Prior studies have not fully clarified which patient or procedural factors influence this risk. Understanding these associations could improve safety and procedural outcomes. This gap motivated a detailed retrospective analysis of HyFoSy procedures using ExEm® Foam. No prior work had resolved the relationship between endometrial thickness and intravasation risk. The absence of clear evidence on this point highlights a need for further investigation. This paper contributes by examining multiple variables in a large cohort of subfertile patients. The study provides insights into how anatomical and procedural factors may influence intravasation rates.

The primary aim of the study was to evaluate the rate of intravasation during HyFoSy procedures using ExEm® Foam. Researchers sought to determine if specific patient or procedural factors could predict intravasation. The study focused on subfertile patients undergoing HyFoSy to assess tubal patency. The goal was to identify variables that might increase or decrease the likelihood of intravasation. The study included a range of factors such as endometrial thickness, pain score, and uterine morphology. These variables were selected based on prior literature and clinical observations. The researchers aimed to provide evidence-based guidance for safer HyFoSy procedures. This analysis could inform clinical practice and procedural adjustments to reduce complications.

The study was a retrospective analysis of HyFoSy procedures conducted between January 2018 and October 2021. A total of 436 subfertile patients were included based on predefined inclusion criteria. Each patient underwent transvaginal sonography before HyFoSy to assess anatomy and endometrial thickness. Subspecialist radiologists performed the HyFoSy with assistance from sonographers. Intravasation was identified in real time and confirmed post-procedure. Patient pain scores were recorded on a scale from 1 to 10 immediately after the procedure. Data on ExEm® Foam volume, uterine length, and adenomyosis severity were collected. Statistical analysis evaluated associations between these variables and intravasation occurrence.

Out of 436 HyFoSy procedures, 30 (6.9%) experienced intravasation. Endometrial thickness and pain score were significantly associated with intravasation. For every millimetre increase in endometrial thickness, the odds of intravasation decreased by 26%. For each point increase in pain score, the odds of intravasation increased by 22%. No significant association was found between ExEm® Foam volume and intravasation. Uterine morphology and adenomyosis severity did not show a statistically significant link to intravasation. These findings suggest that endometrial thickness and pain score are important predictors of intravasation risk. The observed intravasation rate of 6.9% is consistent with prior studies but adds new insights into contributing factors. The results highlight the need for careful monitoring of endometrial thickness and patient-reported pain during HyFoSy procedures.

The study found a 6.9% intravasation rate during HyFoSy procedures using ExEm® Foam. Endometrial thickness and pain score were significantly associated with intravasation. The odds of intravasation decreased with thicker endometrium and increased with higher pain scores. No evidence was found linking ExEm® Foam volume or uterine morphology to intravasation. These findings suggest that endometrial thickness and pain score are important factors to consider during HyFoSy. The authors propose that monitoring these variables could help reduce intravasation risk. The study does not claim that these factors are essential for intravasation prediction. The results are specific to the cohort studied and should be interpreted within that context. The authors suggest further research to validate these associations in larger or more diverse populations.