| Infertility, mainly attributable to the female reason, is considered to be slowly rising."Impervious"fallopian tubes were recognized as the most common cause of female infertility, then the causes of ovary and uterus. In clinical practice, a priority of diagnosis is the early assessment of fallopian tubal patency. At present, the screening test for fallopian tubal patency is hysterosalpingography (HSG) which had been shown to have good diagnostic concordance rate, sensitivity, specificity, positive predictive value and negative predictive value compared with the Lap and Dye. But the disadvantages of HSG were: both patients and doctors suffered from ionizing radiation, and a few of patients were iodo-hypersensitiveness, or took the risk of fallopian tubal obstruction by using of iodipin; Besides, HSG has low sensitivity and specificity for metropathy and ovariopathy."Lap and dye", and"hysteroscopy", regarded as the"gold standards"for the assessment of fallopian tubal patency and uterine cavity respectively, could not be used as screening test due to the anesthesia risk, complication and the cost.Transvaginal ultrasonography plays important role in gynaecology and obstetrics, and the microbubble contrast agent makes it possible for ultrasonography to assess the patency of fallopian tube. Otherwise, gynaecologists have been paying attention on the role of sonohysterography on the diagnosis of diseases in uterine cavity.A new method----- hysterosalpingo-contrast-sonography (Hy Co Sy), described in this paper, was applied as a screening test to examine the causes of female infertility correlated to uterus and fallopian tube. Our study has shown that Hy Co Sy appeared to be both technically feasible for the ultrasonograpers to perform and acceptable as an outpatient procedure to those undergoing examination. The procedures of Hy Co Sy were: 1) the examination by transvaginal ultrasound, 2) sonohysterography, and 3) sonosalpingography. After the completion of all three stages, we had assessed the patency of fallopian tube,detected the diseases in uterine cavity as well as those in myometrium and ovary.At the third stage of Hy Co Sy, the second generation microbubble contrast ----SonoVue, has been applied to assess the patency of fallopian tube in 40 cases. The result had shown good sensitivity, specificity, positive predictive value, negative predictive value and diagnostic concordance rate compared with the gold standard----lap and dye. The outstanding result of negative predictive value made it possible for Hy Co Sy to screen the patency of fallopian tube at a large scale in clinic. At another hand, compared with HSG, Hy Co Sy has shown 90.3% diagnostic concordance rate, 83.3% sensitivity, 94.1% specificity, 88.2% positive predictive value and 91.4% negative predictive value. The side effects of Hy Co Sy was more light than that of HSG: about 37.5% patients undergone Hy Co Sy complained obvious pain and uncomfortable, but 55.6% patients of HSG complained. Otherwise, patients accepting Hy Co Sy did not suffer from iodo-hypersensitiveness and ionizing radiation. Compared with imaging created by another contrast agent----1.5% H2O2, the imaging of Hy Co Sy were much clearer, with less pain and uncomfortable feeling. At the second stage of Hy Co Sy, saline solution was used as a contrast agent in sonohysterography, which has shown high sensitivity (93.3%), specificity (80%), positive predictive value (93.3%) and negative predictive value (80%) in detecting polypi, submucous myoma, intrauterine adhesions and congenital abnormality when compared it with the gold standard----Hysteroscopy. The diagnostic concordance rate was 92.9% compared with histopathology.In addition, we had detected some other diseases contributed to female infertility at the first stage---TVS, such as uterus myoma, ovarian endometriosis and polycystic ovary.Our study has shown that Hy Co Sy could be used as a screening test in the examination of fallopian tube and uterus infertility in clinic.
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