‘One-stop shop’ ultrasound evaluation of an infertile patient: doing less is no longer an option

Sir, We read the article by van Welie et al. (2022) with great interest. The authors conducted a multicenter, prospective, comparative study with a randomized design on 1026 women who underwent hysterosalpingo-foam sonography (HyFoSy) and hysterosalpingography (HSG). Their findings show that using either HyFoSy or HSG in infertile women leads to similar pregnancy outcomes, although HyFoSy is associated with significantly less pain. Van Welie et al. (2022) thus conclude that HyFoSy should be the first-choice tubal patency test during fertility work-ups. However, their study, although highly important, misses a number of crucial steps. The assessment of the uterine cavity, tubal patency and the ovaries constitutes a key component of female infertility work-ups. The benefits of a comprehensive ‘one-stop shop’ concept for the evaluation of the genital tract in infertile patients was initially suggested by Kelly et al. (2001) and reiterated more recently by Groszmann and Benacerraf (2016). They also stressed the value of a single comprehensive ultrasound (US) examination in a sequence composed of a two-dimensional (2D), a three-dimensional (3D) US and a Doppler, followed by sonohysterography to evaluate the uterine cavity, and a hysterosalpingocontrast sonography to assess tubal patency.