HSG versus HyFoSy: Is er een verschil in pijnscore tussen deze twee tubatesten?

When a couple search for help because of the inability to conceive after one year of trying, they will attend a fertility clinic and get a fertility work-up at the gynaecologist. Tubal patency testing is part of this fertility work-up. There are several tests available for tubal patency testing, including laparoscopy with chromopertubation of the fallopian tubes, hysterosalpingography (HSG), Hysterosalpingo Contrast Sonography (HyCoSy) and Hysterosalpingo-foam Sonography (HyFoSY).



A commonly used medium for HyCoSy was Echovist, but this medium has become no longer available for patency testing because of a possible allergic reaction on this medium when known with galactose allergy. So that meaned that there was no sonographic tubal patency test available anymore.



In 2007 a new medium (Ex-Em-gel®) for gynaecologic sonography was introduces by GynaecologIQ. This is a non(embryo-) toxic gel, containing hydroxyethylcellulose and glycerol. This medium can be used for sonographic patency testing; Hysterosalpingo-foam Sonography (HyFoSy). During the sonography, a little amount of foam is introduced into the uterine cavity through a little cervical balloon-less applicator, connected to a syringe with foam. The foam is created by rigorously mixing 10 ml ExEm-gel® with 10 ml of purified water in a 20 ml syringe. This recipe turned out to be excellent for creating foam that was sufficiently stable to show echogenicety for at least 5 minutes and for providing sufficient fluid to pass through patent tubes.



Recently Emanuel et al showed in their prospective observational cohort study that HyFoSy is a successful procedure to demonstrate tubal patency as a first step office procedure. In 78 % there was no need for HSG after HyFoSy.



The aim of our study is to investigate if a HyFoSy is less painful compared to the first step office procedure for tubal patency testing: HSG. The fact that 78% of subfertile women, with a low risk of tubal pathology, don’t need HSG. Gives us a need to know if a HyFoSy is less aggravating compared to HSG.

The primary hypothesis is that tubal patency test by a HyFoSy procedure is less painful compared to tubal patency test by a hysterosalpingography.

20 minutes post HyFoSy or HSG.

Tubal patency testing by Hysterosalpingo-Foam Sonography versus Hysterosalpingography.