Comparison of hysterosalpingo-foam sonography vs. hysterosalpingography: a prospective observational study

To study the diagnostic concordance and tolerability of hysterosalpingo-foam sonography (HyFoSy) compared with hysterosalpingography (HSG) in the evaluation of tubal patency.

Prospective observational study conducted between 2023 and 2024 in a Spanish hospital, using a within-subject comparative design.

A total of 117 women undergoing fertility evaluation.

All participants underwent both HyFoSy and HSG for assessment of tubal patency.

Diagnostic concordance between HyFoSy and HSG (Cohen's kappa coefficient), pain assessment using the visual analogue scale (VAS), and procedure-related complications.

Complete concordance between HyFoSy and hysterosalpingography was obtained in 100 patients (85.4%), of whom 85 had normal patency, and 15 had some patency defect (moderate agreement with a kappa coefficient of 0.575). In 12 patients (10.2%), there were discordant diagnoses, and in five patients (4.3%), concordance could not be assessed. Hysterosalpingo-foam sonography was better tolerated in terms of reported pain, while HSG had a significantly higher median pain score. Only minor complications were recorded during the performance of both techniques, mainly slight vaginal bleeding and vasovagal discomfort.

Our study shows HyFoSy is an effective, safe and better-tolerated technique than HSG, with a similar diagnostic rate for the study of tubal patency defects.