Prevalence of contrast intravasation in HyCoSy/HyFoSy. Results of a multicenter study and systematic review of the literature with meta-analysis

Alcazar J. L.;Penate L.;Casanova V.;Piera C.;Engels V.;Medina M.;Ros C.;Sotillo L.;Antolin E.;Pelayo I.;Bermejo C.;Pascual M. A.;Graupera B.;Barreche I.;Orozco R.;Ajossa S.;Guerriero S.

2025-01-01

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Abstract

Objective: To determine the frequency of uterine contrast agent intravasation during HyCoSy/HyFoSy for assessing tubal patency in infertile women. Methods: Prospective observational multicenter study performed in nine European university hospitals, comprising a series of non-consecutive women who underwent HyFoSy (ExEmTM foam) for tubal patency assessment in the context of infertility between May 2016 and December 2022. All examinations were performed using the same scanning protocol. In addition, a systematic review of literature using database search (Pubmed, Scopus and Web of Science) of articles published between January 2000 and March 2024 evaluating the presence of venous contrast intravasation during HyCoSy/HyFoSy for assessment of tubal patency in infertile women. Pooled prevalence for intravasation was estimated. Heterogeneity was assessed by calculating I2. Quality of studies was assessed using the Newcastle-Ottawa scale. Results: Prospective study: 1946 women were recruited. Intravasation was observed in 12 cases (0.6 %, 95 % CI: 0.5 %–0.9 %). The frequency of intravasation was similar in seven centers, ranging from 0 % to 0.7 %. In two centers the frequency observed was higher, 2.6 % and 3.0 %, respectively. No significant patient reaction or complication was observed in those 12 women with intravasation. In addition, the search identified 74 studies. After exclusions, 11 articles (9 using SonoVueTM and 2 using ExEmTM foam) were included, comprising data from 5028 women. Pooled prevalence for contrast intravasation was significantly higher for SonoVueTM (23.0 %, 95 %CI: 19.0 %–27.0 %) than for ExEmFoam (7.0 %, 95 %CI: 5.0 %–9.0 %). Heterogeneity was high (I2: 91.8 %). Studies quality was good. Conclusion: Uterine intravasation is less frequent using ExEmTM foam than SonoVueTM.