Three-dimensional Hysterosalpingo Contrast Sonography with Lignosal as Contrast for Evaluation of Tubal Patency in the Infertile Women – An Observational Cohort Study

Abstract

Objectives The objectives of the study were to evaluate the two-dimensional (2D)/three-dimensional (3D) hysterosalpingo contrast sonography (HyCoSy) using lignosal (a mixture of lignocaine 2% jelly with normal saline) as a contrast agent for assessing fallopian tubal patency in infertile patients. Materials and Methods After obtaining the Institutional Review Board permission, a single center prospective study was conducted to evaluate the validity of 3D-HyCoSy with lignosal to assess the patency of fallopian tubes in infertile women. In total 540 infertile patients were recruited for this study. Bilateral fallopian tube patency was confirmed when fallopian tubes were seen as echogenic tubular structures with peritoneal spill under real-time 3D/2D-HyCoSy. Results In the first phase of the study, 2D-HyCoSy without 3D acquisition was made in 20 patients (40 tubes). 2D-HyCoSy with lignosal contrast shown tubal patency in 95% and radiographic hysterosalpingography (HSG) resulted in 97.5% tubal patency with 5% inconclusive results by HyCoSy. In the second phase, data from 520 patients showed bilateral tubal patency in 463 patients (89.03%), unilateral tubal occlusion in 49 patients (9.42%), and bilateral tubal occlusion in eight patients (1.53%). No untoward side effects were noticed and reported by the patients during and after the HyCoSy procedure with lignosal. Conclusions 3D-HyCoSy with lignosal allowed the entire length of the fallopian tubes to be seen as contrast moved through the fallopian tubes to the fimbrial end. A “shower” of contrast around the ovaries is visualized confirming the peritoneal spill. Use of lignosal provides an alternative imaging method for evaluating the tubal patency in infertile patients.