• Contrast agents
• Hysterosonopalpingography
• Intravasation
• Uterine

• Humans
• Female
• Contrast Media/adverse effects
• Contrast Media/administration & dosage
• Prospective Studies
• Infertility, Female/diagnostic imaging
• Adult
• Fallopian Tube Patency Tests/methods
• Prevalence
• Extravasation of Diagnostic and Therapeutic Materials/epidemiology

• Hysterosalpingo-foam sonography
• Laparoscopy
• Tubal patency assessment

• Humans
• Female
• Infertility, Female/diagnostic imaging
• Adult
• Fallopian Tubes/diagnostic imaging
• Ultrasonography/methods
• Fallopian Tube Patency Tests/methods
• Prospective Studies
• Laparoscopy
• Sensitivity and Specificity
• Young Adult
• Hysterosalpingography/methods

• ExEm® Foam
• HSG
• HyCoSy
• HyFoSy
• ultrasound

• Female
• Humans
• Fallopian Tubes/diagnostic imaging
• Adenomyosis
• Retrospective Studies
• Infertility, Female/etiology
• Hysterosalpingography/adverse effects
• Ultrasonography
• Pain/etiology
• Contrast Media
• Fallopian Tube Patency Tests/adverse effects

• Saline infusion sonohysterography (SIS)
• hydrosalpinx
• hysterosalpingo-contrast sonography (HyCoSy)
• hysterosalpingography (HSG)
• hysteroscopy

T-shaped uterus is a Müllerian malformation with unapparent clinical manifestations. Intrauterine adhesion and tuberculosis may lead to T-shaped uterus, too. Hysteroscopic metroplasty is a treatment option for T-shaped uterus, while the postoperative reproductive outcomes have not been thoroughly investigated. The aim of this study was to determine the reproductive outcome in Chinese women with T-shaped uterus who had hysteroscopic metroplasty with cold scissors.

This retrospective cohort study was conducted in the reproductive surgery unit of a university-affiliated hospital. One hundred and eleven patients with T-shaped uterus who underwent hysteroscopic metroplasty from Jan. 2017 to Sept. 2019 were followed-up by telephone in Apr. 2021. All patients received hysteroscopic metroplasty using microcissors, followed by estrogen-progesterone sequential treatment, with or without intrauterine device (IUD) implantation. According to whether they had had history of intrauterine operation, patients were divided into congenital group and acquired group. The main outcome measure was postoperative live birth rate. χ² test and t test were used for comparison between groups. Cochran-Mantel–Haenszel test were used for stratified analysis. P < 0.05 was considered statistically significant.

One hundred and eleven patients were included in total, with 46 in congenital group and 65 in acquired group. After hysteroscopic metroplasty, in the congenital group, the pregnancy rate increased from 28.3% to 87.0% (P < 0.001) and the live birth rate increased from 23.1% to 79.5% (P = 0.001); in the acquired group, the pregnancy rate slightly dropped from 98.5% to 72.3% (P < 0.001) while the live birth rate increased from 20.8% to 74.5% (P < 0.001). No statistically significant difference was observed in postoperative reproductive outcome indicators between the two subgroups except mode of conception.

For both groups, hysteroscopic metroplasty may improve reproductive outcomes for patients with T-shaped uterus.

The online version contains supplementary material available at 10.1186/s12978-022-01381-2.

As a Müllerian malformation, T-shaped uterus is named for the shape of the uterine cavity. According to cause of the disease and patients’ intrauterine operation history, T-shaped uterus can be divided into congenital and acquired types.

This study was conducted in the reproductive surgery unit in a university-affiliated hospital. Data were collected from medical records, and patients were followed up via telephone.

One hundred and eleven patients were included in this study, with 46 in congenital group and 65 in acquired group. Whether infertility/subfertility patients had had intrauterine operation history or not, their rates of giving live birth increased after the hysteroscopic metroplasty.

In conclusion, hysteroscopic metroplasty is an effective intervention for T-shaped uterus patients with fertility intention.

• Hysteroscopic metroplasty
• Infertility
• Reproductive outcome
• T-shaped uterus

• Contrast media Exem Foam
• Hysterosalpingo-foam sonography (HyFoSy)
• Infertility
• Tubal patency test
• Ultrasonography

Does hysterosalpingo-foam sonography (HyFoSy) lead to similar pregnancy outcomes, compared with hysterosalpingography (HSG), as first-choice tubal patency test in infertile couples?

HyFoSy and HSG produce similar findings in a majority of patients and clinical management based on the results of either HyFoSy or HSG, leads to comparable pregnancy outcomes. HyFoSy is experienced as significantly less painful.

Traditionally, tubal patency testing during fertility work-up is performed by HSG. HyFoSy is an alternative imaging technique lacking ionizing radiation and iodinated contrast medium exposure which is less expensive than HSG. Globally, there is a shift towards the use of office-based diagnostic methods, such as HyFoSy.

This multicentre, prospective, comparative study with a randomized design was conducted in 26 hospitals in The Netherlands. Participating women underwent both HyFoSy and HSG in randomized order. In case of discordant results, women were randomly allocated to either a management strategy based on HyFoSy or one based on HSG.

We included infertile women between 18 and 41 years old who were scheduled for tubal patency testing during their fertility work-up. Women with anovulatory cycles not responding to ovulation induction, endometriosis, severe male infertility or a known iodine contrast allergy were excluded. The primary outcome for the comparison of the HyFoSy- and HSG-based strategies was ongoing pregnancy leading to live birth within 12 months after inclusion in an intention-to-treat analysis.

Between May 2015 and January 2019, 1026 women underwent HyFoSy and HSG. HyFoSy was inconclusive in 97 of them (9.5%), HSG was inconclusive in 30 (2.9%) and both were inconclusive in 9 (0.9%). In 747 women (73%) conclusive tests results were concordant. Of the 143/1026 (14%) with discordant results, 105 were randomized to clinical management based on the results of either HyFoSy or HSG. In this group, 22 of the 54 women (41%) allocated to management based on HyFoSy and 25 of 51 women (49%) allocated to management based on HSG had an ongoing pregnancy leading to live birth (Difference −8%; 95% CI: −27% to 10%). In total, clinical management based on the results of HyFoSy was estimated to lead to a live birth in 474 of 1026 women (46%) versus 486 of 1026 (47%) for management based on HSG (Difference −1.2%; 95% CI: −3.4% to 1.5%). Given the pre-defined margin of −2%, statistically significant non-inferiority of HyFoSy relative to HSG could not be demonstrated (P = 0.27). The mean pain score for HyFoSy on the 1–10 Visual Analogue Scale (VAS) was 3.1 (SD 2.2) and the mean VAS pain score for HSG was 5.4 (SD 2.5; P for difference < 0.001).

Since all women underwent both tubal patency tests, no conclusions on a direct therapeutic effect of tubal flushing could be drawn.

HyFoSy or HSG produce similar tubal pathology findings in a majority of infertile couples and, where they differ, a difference in findings does not lead to substantial difference in pregnancy outcome, while HyFoSy is associated with significantly less pain.

The FOAM study was an investigator-initiated study funded by ZonMw, The Netherlands organization for Health Research and Development (project number 837001504). ZonMw funded the whole project. IQ Medical Ventures provided the ExEm-foam^® kits free of charge. The funders had no role in study design, collection, analysis and interpretation of the data. K.D. reports travel and speaker fees from Guerbet. F.J.M.B. reports personal fees as a member of the external advisory board for Merck Serono, The Netherlands, and a research support grant from Merck Serono, outside the submitted work. C.B.L. reports speakers’ fee from Ferring in the past, and his department receives research grants from Ferring, Merck and Guerbet. J.S. reports a research agreement with Takeda on MR of motility outside the submitted work. M.V.W. reports leading The Netherlands Satellite of the Cochrane Gynaecology and Fertility Group. B.W.J.M. is supported by an NHMRC Investigator grant (GNT1176437). B.W.J.M. reports consultancy for Guerbet and research funding from Merck and Guerbet. V.M. reports non-financial support from IQ medicals ventures, during the conduct of the study; grants and personal fees from Guerbet, outside the submitted work. The other authors do not report conflicts of interest.

NTR4746/NL4587 (https://www.trialregister.nl)

19 August 2014

7 May 2015

• Adolescent
• Adult
• Female
• Humans
• Hysterosalpingography/adverse effects
• Infertility, Female/diagnostic imaging
• Infertility, Female/therapy
• Male
• Pain
• Pregnancy
• Pregnancy Rate
• Prospective Studies
• Young Adult

• ZonMw
• The Netherlands organization for Health Research and Development

• Feasibility
• Hysterosalpingocontrast sonography
• Tolerability
• Tubal patency

• Green urine sign
• chromopertubation
• infertility diagnosis
• intravasation
• methylene blue
• tubal patency

• Fallopian Tube Diseases/diagnostic imaging
• Fallopian Tube Patency Tests
• Female
• Humans
• Hysterosalpingography
• Infertility, Female
• Laparoscopy

• Uniwersytet Medyczny w Lublinie