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

OBJECTIVE: To study the diagnostic concordance and tolerability of hysterosalpingo-foam sonography (HyFoSy) compared with hysterosalpingography (HSG) in the evaluation of tubal patency. DESIGN: Prospective observational study conducted between 2023 and 2024 in a Spanish hospital, using a within-subject comparative design. SUBJECTS: A total of 117 women undergoing fertility evaluation. EXPOSURE: All participants underwent both HyFoSy and HSG for assessment of tubal patency. MAIN OUTCOME MEASURES: Diagnostic concordance between HyFoSy and HSG (Cohen's kappa coefficient), pain assessment using the visual analogue scale (VAS), and procedure-related complications. RESULTS: 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. CONCLUSIONS: 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.