Value of sonographic hydrotubation using agitated saline as a screening test for tubal patency

Establishing tubal patency is necessary for the treatment of subfertility. Hysterosalpingo contrast sonography (HyCoSy) is one of recommended screening test but is expensive. Vaginal sonographic hydrotubation using agitated saline and size 8 Foley catheter can be used to reduce the cost. The objective of the study is to determine the diagnostic accuracy of vaginal sonographic hydrotubation using agitated saline as a screening test for tubal patency. 42 patients with infertility were evaluated for tubal patency. Vaginal sonographic hydrotubation was performed using a size 8 Foley urinary catheter and agitated saline solution as a contrast medium to assess tubal patency. Results were compared with findings at laparoscopy and chromotubation performed independently. All patients received prophylactic antibiotics prior to procedure. The findings of both methods agreed in 71 out of 84 tubes (concordance, 84.5%). The sensitivity for tubal patency was 84.9% and the specificity 81.8%. The positive predictive value 96.8% and the negative predictive value was 45.0%. The pretest probability was 86% and posttest probability 96%. Adverse events included moderate to severe abdominal pain in two patients and mild discomfort during procedure. No infectious complications recorded. From the study it can be concluded that vaginal sonographic hydrotubation utilizing agitated saline as a contrast medium and a size 8 Foley urinary catheter is a reliable, simple and well-tolerated method to assess tubal patency in an outpatient setting. In addition, detection of other pathologies related to subfertility is also possible at the time of screening.