Is hysterosalpingo-foam sonography the new gold standard for assessing tubal patency? A systematic review and meta-analysis.

The aim of this study was to compare hysterosalpingo-foam sonography (HyFosy) with other tubal patency tests to analyse its efficacy, safety and tolerance. A systematic review and meta-analysis were performed following the Cochrane Collaboration and PRISMA guidelines by searching PubMed and the Cochrane Library using the term 'HyFosy'. In total, 20 studies, published from 2012 to January 2023, were included in this review. Information about the identification of tubal patency, agreement with laparoscopy, pain intensity, procedure failure, occurrence of pregnancy, side effects and treatment modalities was extracted. In 94% of patients, HyFosy had the same result as laparoscopy. No difference was found between HyFosy and hysterosalpingography (HSG) in terms of identification of tubal patency [total risk ratio (TRR) 0.98, 95% CI 0.88-1.10] and procedure failure (TRR 0.47, 95% CI 0.07-3.05). The visual analogue scale pain score was in favour of HyFosy (TRR 1.09, 95% CI 1.00-1.17); 95% of patients scored <6. Only 1% of patients had procedure failure or side effects after undergoing HyFosy. HyFosy is at least as efficient as HSG. HyFosy should be fully integrated as a first-line tool for the assessment of tubal patency. New guidelines for the inclusion of HyFosy in the assessment of tubal patency and standardization of this new procedure are essential.