Three- or four-dimensional hysterosalpingo contrast sonography for diagnosing tubal patency in infertile females: a systematic review with meta-analysis

Abstract

Objective: To assess the diagnostic value of three-dimensional (3D) or four-dimensional (4D) hysterosalpingo contrast sonography (HyCoSy) for detecting tubal patency in infertile females.

Methods: A comprehensive search was conducted to identify related research. The pooled results were calculated by diagnostic meta-analysis with bivariate mixed-effects binary regression. Subgroup analyses and publication bias were further performed.

Results: 23 studies, including 1153 females with 2259 detected fallopian tubes, were identified. The pooled estimates of sensitivity and specificity were 0.92 [95% confidence interval (CI): 0.90-0.94, I(2) = 36.68] and 0.91 (95% CI: 0.89-0.93, I(2) = 38.99), respectively. The area under the receiver-operating characteristic curve was 0.97 (95% CI: 0.95-0.98). No publication bias was observed.

Conclusion: 3D/4D HyCoSy is an accurate test for diagnosing tubal patency in infertile females.

Advances in knowledge: 3D/4D HyCoSy is an accurate test for diagnosing tubal patency in females suffering from infertility, whilst overcoming some main limitations of other methods. 3D/4D HyCoSy is recommended as a fundamental test for female infertility.

Figure 1.

Flow diagram of study selection in meta-analysis. 3D/4D HyCoSy, three-dimensional or four-dimensional hysterosalpingo contrast sonography.

Figure 2.

Risk of bias and applicability concerns based on the Quality Assessment of Diagnostic Accuracy Study 2 presented as percentages across included studies.

Figure 3.

Forest plot of three-dimensional or four-dimensional hysterosalpingo contrast sonography (sensitivity and specificity) for diagnosing tubal patency. CI, confidence interval; df, degree of freedom; Ref, reference.

Figure 4.

Summary receiver-operating characteristic (SROC) curve for diagnosing tubal patency. The numbers in the circles are listed in Table 1. AUC, area under the curve; SENS, sensitivity; SPEC, specificity.

Figure 5.

Funnel plot and Deek's funnel plot asymmetry test of this diagnostic meta-analysis. The numbers in circles are listed in Table 1. ESS, effective sample size.