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

Juan Luis Alcazar; Laura Peñate; Virgina Casanova; Clara Piera; Virginia Engels; Margarita Medina; Cristina Ros; Laura Sotillo; Eugenia Antolín; Irene Pelayo; Carmina Bermejo; María Ángela Pascual; Betlem Graupera; Irene Barreche; Rodrigo Orozco; Silvia Ajossa; Stefano Guerriero

doi:10.1016/j.ejogrb.2024.12.004

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

Eur J Obstet Gynecol Reprod Biol. 2024 Dec 9:305:100-106. doi: 10.1016/j.ejogrb.2024.12.004. Online ahead of print.

Authors

Juan Luis Alcazar¹, Laura Peñate², Virgina Casanova³, Clara Piera⁴, Virginia Engels⁵, Margarita Medina⁶, Cristina Ros⁷, Laura Sotillo⁵, Eugenia Antolín⁵, Irene Pelayo⁸, Carmina Bermejo⁹, María Ángela Pascual¹⁰, Betlem Graupera¹⁰, Irene Barreche¹¹, Rodrigo Orozco¹¹, Silvia Ajossa¹², Stefano Guerriero¹²

Affiliations

¹ Department of Obstetrics and Gynecology, Hospital QuirónSalud, Málaga, Spain; Faculty of Medicine, University of Navarra, Pamplona, Spain. Electronic address: jlalcazar@unav.es.
² Department of Obstetrics and Gynecology, Torrejon University Hospital, Torrejon de Ardoz, Spain.
³ Department of Obstetrics and Gynecology, Hospital Virgen de la Luz, Cuenca, Spain.
⁴ Department of Obstetrics and Gynecology, Hospital Denia, Denia, Spain.
⁵ Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Hospital Universitario La Paz. IdiPAZ Madrid, Spain.
⁶ Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, Las Palmas de Gran Canaria, Spain.
⁷ Department of Gynecology, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
⁸ Department of Obstetrics and Gynecology, Hospital Universitario Ramón y Cajal, Alcala de Henares University, Madrid, Spain.
⁹ Delta Ecografía, Madrid, Spain.
¹⁰ Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain.
¹¹ Department of Obstetrics and Gynecology, Hospital QuirónSalud, Málaga, Spain.
¹² Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Policlinico Universitario Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy.

PMID: 39673914
DOI: 10.1016/j.ejogrb.2024.12.004

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 (ExEm^TM 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 SonoVue^TM and 2 using ExEm^TM foam) were included, comprising data from 5028 women. Pooled prevalence for contrast intravasation was significantly higher for SonoVue^TM (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 ExEm^TM foam than SonoVue^TM.

Keywords: Contrast agents; Hysterosonopalpingography; Intravasation; Uterine.