{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:22:48Z","timestamp":1791390168111,"version":"4.3.3"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>In recent years, the incidence of infertility has been on the rise, and accurately evaluating the tubal status is of great significance in the diagnostic work-up of infertile women. HyCoSy has a certain proportion of false positives and false negatives in the evaluation of fallopian tube patency. The new third-generation drug-or gene-loaded microbubble contrast agents will largely achieve the dual purpose of diagnosis and treatment in clinical application, especially in transvaginal four-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy), which has significant clinical value in assessing tubal patency and perifallopian tube adhesions. This study mainly discusses the selection of current diagnostic methods for tubal infertility, the technical challenges, and suggestions for ultrasonic diagnosis and postoperative treatment.<\/jats:p>","DOI":"10.3389\/fmed.2025.1537506","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T04:10:43Z","timestamp":1745554243000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical applications, advances, and future directions in hysterosalpingography"],"prefix":"10.3389","volume":"12","author":[{"given":"Ting","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiantian","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Nie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1002\/uog.11085","article-title":"Value of three-dimensional hysterosalpingo-contrast sonography with sonovue in the assessment of tubal patency","volume":"40","author":"Zhou","year":"2012","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1038\/s41572-018-0058-8","article-title":"Female subfertility","volume":"5","author":"Farquhar","year":"2019","journal-title":"Nat Rev Dis Primers."},{"key":"B3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1001\/jama.2021.4788","article-title":"Diagnosis and management of infertility: a review","volume":"326","author":"Carson","year":"2021","journal-title":"JAMA."},{"key":"B4","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1136\/jclinpath-2018-205579","article-title":"Investigation and management of subfertility","volume":"72","author":"Thurston","year":"2019","journal-title":"J Clin Pathol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.jmig.2019.03.006","article-title":"Assessment of tubal patency: a prospective comparison of diagnostic hysteroscopy and laparoscopic chromopertubation","volume":"27","author":"Ott","year":"2020","journal-title":"J Minim Invasive Gynecol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1016\/j.jmig.2014.05.017","article-title":"Contrast ultrasonography for tubal patency","volume":"21","author":"Luciano","year":"2014","journal-title":"J Minim Invasive Gynecol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.ejogrb.2014.09.032","article-title":"Clinical analysis of transvaginal hydrolaparoscopy in infertile patients","volume":"182","author":"Zhang","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/humrep\/dex013","article-title":"Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air\/saline and to laparoscopy with dye","volume":"32","author":"Ludwin","year":"2017","journal-title":"Hum Reprod."},{"key":"B9","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.jmig.2012.03.016","article-title":"Accuracy of assessment of tubal patency with selective pertubation at office hysteroscopy compared with laparoscopy in infertile women","volume":"19","author":"T\u00f6r\u00f6k","year":"2012","journal-title":"J Minim Invasive Gynecol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e0226264","DOI":"10.1371\/journal.pone.0226264","article-title":"Dye diffusion during laparoscopic tubal patency tests may suggest a lymphatic contribution to dissemination in endometriosis: a prospective, observational study","volume":"14","author":"Scioscia","year":"2019","journal-title":"PLoS One."},{"key":"B11","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1055\/s-0031-1272471","article-title":"Transvaginal hydrolaparoscopy","volume":"29","author":"Catenacci","year":"2011","journal-title":"Semin Reprod Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.7863\/jum.2005.24.9.1267","article-title":"The use of contrasted transvaginal sonography in the diagnosis of gynecologic diseases: a preliminary study","volume":"24","author":"Testa","year":"2005","journal-title":"J Ultrasound Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1016\/j.fertnstert.2008.07.1746","article-title":"Two-dimensional HyCoSy with contrast tuned imaging technology and a second-generation contrast media for the assessment of tubal patency in an infertility program","volume":"92","author":"Lanzani","year":"2009","journal-title":"Fertil Steril."},{"key":"B14","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12905-025-03598-2","article-title":"Diagnostic value of multimodal hysterosalpingo-contrast sonography combined with negative intrauterine contrast-enhanced ultrasound in female infertility","volume":"25","author":"Fu","year":"2025","journal-title":"BMC Womens Health."},{"key":"B15","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1002\/jum.15677","article-title":"The performance of transvaginal two-dimensional fundamental sonosalpingography combined with saline infusion pelvic sonosalpingography for assessing fimbrial part's morphology and function of the fallopian tubes","volume":"41","author":"Xu","year":"2022","journal-title":"J Ultrasound Med."},{"key":"B16","first-page":"777","article-title":"Diagnostic accuracy of saline infusion sonohystero-salpingography (SIS) as compared to hystero-salpingography (HSG) in the assessment of sub-fertile women","volume":"69","author":"Izhar","year":"2019","journal-title":"J Pak Med Assoc."},{"key":"B17","doi-asserted-by":"publisher","first-page":"28","DOI":"10.3748\/wjg.v17.i1.28","article-title":"Contrast-enhanced and targeted ultrasound","volume":"17","author":"Postema","year":"2011","journal-title":"World J Gastroenterol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1080\/09513590600647359","article-title":"Hysteroscopy combined with hysterosalpingo contrast sonography (HyCoSy): a new modality for comprehensive evaluation of the female pelvic organs","volume":"22","author":"Horowitz","year":"2006","journal-title":"Gynecol Endocrinol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s12905-018-0556-6","article-title":"The FOAM study: is hysterosalpingo foam sonography (HyFoSy) a cost-effective alternative for hysterosalpingography (HSG) in assessing tubal patency in subfertile women? Study protocol for a randomized controlled trial","volume":"18","author":"Van Rijswijk","year":"2018","journal-title":"BMC Womens Health."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1002\/jum.14483","article-title":"Prospective study of concordance between hysterosalpingo-contrast sonography and hysteroscopy for evaluation of the uterine cavity in patients undergoing infertility studies","volume":"37","author":"Calles-Sastre","year":"2018","journal-title":"J Ultrasound Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.ejogrb.2014.12.013","article-title":"Hysterosalpingo-contrast-sonography (HyCoSy) in the assessment of tubal patency in endometriosis patients","volume":"186","author":"Moro","year":"2015","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.jmig.2009.03.019","article-title":"Contrast-tuned imaging and second-generation contrast agent sonovue: a new ultrasound approach to evaluation of tubal patency","volume":"16","author":"Exacoustos","year":"2009","journal-title":"J Minim Invasive Gynecol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.ajog.2010.08.065","article-title":"Can hysterosalpingo-contrast sonography replace hysterosalpingography in confirming tubal blockage after hysteroscopic sterilization and in the evaluation of the uterus and tubes in infertile patients?","volume":"204","author":"Luciano","year":"2011","journal-title":"Am J Obstet Gynecol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1111\/j.0001-6349.2005.00797.x","article-title":"Comparison of three-dimensional hysterosalpingo-contrast-sonography and diagnostic laparoscopy with chromopertubation in the assessment of tubal patency for the investigation of subfertility","volume":"84","author":"Chan","year":"2005","journal-title":"Acta Obstet Gynecol Scand."},{"key":"B25","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s00404-014-3465-4","article-title":"Hysterosalpingo contrast sonography (HyCoSy): let's make the point!","volume":"291","author":"Lo Monte","year":"2015","journal-title":"Arch Gynecol Obstet"},{"key":"B26","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1002\/uog.7442","article-title":"Automated sonographic tubal patency evaluation with three-dimensional coded contrast imaging (CCI) during hysterosalpingo-contrast sonography (HyCoSy)","volume":"34","author":"Exacoustos","year":"2009","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.ejogrb.2006.10.010","article-title":"2D and 3D hysterosalpingo-contrast-sonography in the assessment of uterine cavity and tubal patency","volume":"133","author":"Kupesic","year":"2007","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1159\/000443955","article-title":"Three-dimensional hysterosalpingo-contrast-sonography for the assessment of tubal patency in women with infertility: a systematic review with meta-analysis","volume":"81","author":"Alc\u00e1zar","year":"2016","journal-title":"Gynecol Obstet Invest."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.7863\/ultra.33.11.1889","article-title":"Combination of 2- and 3-dimensional contrast-enhanced transvaginal sonography for diagnosis of small adnexal masses","volume":"33","author":"Hu","year":"2014","journal-title":"J Ultrasound Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.ultrasmedbio.2012.11.008","article-title":"Value of three-dimensional contrast-enhanced ultrasound in the diagnosis of small adnexal masses","volume":"39","author":"Xiang","year":"2013","journal-title":"Ultrasound Med Biol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.7863\/ultra.32.7.1233","article-title":"First experience using 4-dimensional hysterosalpingo-contrast sonography with SonoVue for assessing fallopian tube patency","volume":"32","author":"He","year":"2013","journal-title":"J Ultrasound Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/j.jmig.2016.12.011","article-title":"Hysterosalpingo-contrast sonography with four-dimensional technique for screening fallopian tubal patency: let's make an exploration","volume":"24","author":"Chen","year":"2017","journal-title":"J Minim Invasive Gynecol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"547","DOI":"10.7863\/ultra.15.11056","article-title":"Comparison of assessment methods for fallopian tubal patency and peritubal adhesion between transvaginal 4-dimensional hysterosalpingo-contrast sonography and laparoscopic chromopertubation","volume":"36","author":"He","year":"2017","journal-title":"J Ultrasound Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1186\/s12884-020-03315-x","article-title":"Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography","volume":"20","author":"Liu","year":"2020","journal-title":"BMC Pregnancy Childbirth."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e210","DOI":"10.1097\/AOG.0000000000001768","article-title":"174: Evaluation and management of adnexal masses","volume":"128","year":"2016","journal-title":"Obstet Gynecol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1093\/humrep\/deu024","article-title":"Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review with meta-analysis","volume":"29","author":"Maheux-Lacroix","year":"2014","journal-title":"Hum Reprod."},{"key":"B37","doi-asserted-by":"publisher","first-page":"9408141","DOI":"10.1155\/2019\/9408141","article-title":"Combined real-time three-dimensional hysterosalpingo-contrast sonography with B mode hysterosalpingo-contrast sonography in the evaluation of fallopian tube patency in patients undergoing infertility investigations","volume":"2019","author":"Chen","year":"2019","journal-title":"Biomed Res Int."},{"key":"B38","doi-asserted-by":"publisher","first-page":"e17461","DOI":"10.1016\/j.heliyon.2023.e17461","article-title":"Evaluation of tubal patency by hysterosalpingo-contrast sonography (HyCoSy): controversies, dilemmas and considerations","volume":"9","author":"Xu","year":"2023","journal-title":"Heliyon."},{"key":"B39","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1136\/bmj.327.7415.610","article-title":"ABC of subfertility. Tubal subfertility","volume":"327","author":"Khalaf","year":"2003","journal-title":"BMJ."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1016\/j.fertnstert.2008.07.1777","article-title":"Tolerability, side effects, and complications of hysterosalpingocontrast sonography (HyCoSy)","volume":"92","author":"Savelli","year":"2009","journal-title":"Fertil Steril."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.3390\/polym14081568","article-title":"Development of a dual drug-loaded, surfactant-stabilized contrast agent containing oxygen","volume":"14","author":"Patel","year":"2022","journal-title":"Polymers."},{"key":"B42","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1166\/jbn.2015.2020","article-title":"Nanoparticle-assisted combinatorial therapy for effective treatment of endometriosis","volume":"11","author":"Singh","year":"2015","journal-title":"J Biomed Nanotechnol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1093\/biolre\/ioae073","article-title":"Targeted nanoparticles for imaging and therapy of endometriosis\u2020","volume":"110","author":"Slayden","year":"2024","journal-title":"Biol Reprod."},{"key":"B44","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4103\/njcp.njcp_376_17","article-title":"Diagnostic value of transvaginal four-dimensional hysterosalpingo-contrast sonography combined with recanalization in patients with tubal infertility","volume":"22","author":"Gao","year":"2019","journal-title":"Niger J Clin Pract."},{"key":"B45","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1093\/humupd\/dmq056","article-title":"Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathology? An individual patient data meta-analysis","volume":"17","author":"Broeze","year":"2011","journal-title":"Hum Reprod Update."},{"key":"B46","doi-asserted-by":"publisher","first-page":"583","DOI":"10.2147\/IJWH.S359467","article-title":"Development of a nomogram for predicting intravasation before transvaginal 4-dimensional hysterosalpingo-contrast sonography","volume":"14","author":"Jin","year":"2022","journal-title":"Int J Womens Health."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1759","DOI":"10.1148\/radiographics.20.6.g00nv211759","article-title":"A review of selective salpingography and fallopian tube catheterization","volume":"20","author":"Thurmond","year":"2000","journal-title":"Radiographics."},{"key":"B48","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1093\/humrep\/dex022","article-title":"Fallopian tube catheterization in the treatment of proximal tubal obstruction: a systematic review and meta-analysis","volume":"32","author":"De Silva","year":"2017","journal-title":"Hum Reprod."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1016\/j.fertnstert.2021.08.038","volume":"116","year":"2021","journal-title":"Fertil Steril."},{"key":"B50","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s00404-011-2060-1","article-title":"The value of laparoscopy alone or combined with hysteroscopy in the treatment of interstitial pregnancy: analysis of 22 cases","volume":"285","author":"Cai","year":"2012","journal-title":"Arch Gynecol Obstet."},{"key":"B51","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ejogrb.2021.07.025","article-title":"Operative hysteroscopy in the minimally invasive management of interstitial pregnancy and interstitially retained products of conception: a case report and systematic literature review","volume":"265","author":"D'hoore","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1016\/j.jmig.2020.10.026","article-title":"Optimal isthmocele management: hysteroscopic, laparoscopic, or combination","volume":"28","author":"Mashiach","year":"2021","journal-title":"J Minim Invasive Gynecol."},{"key":"B53","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.ejogrb.2020.08.008","article-title":"The pregnancy rate of infertile patients with proximal tubal obstruction 12 months following selective salpingography and tubal catheterization","volume":"254","author":"Pyra","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B54","doi-asserted-by":"publisher","first-page":"e2022","DOI":"10.4293\/JSLS.2022.00047","article-title":"Fluoroscopically-guided hysteroscopic tubal cannulation: a procedure for proximal tubal obstruction","volume":"26","author":"Keltz","year":"2022","journal-title":"JSLS."},{"key":"B55","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3399\/bjgp14X676609","article-title":"Assessment and treatment for people with fertility problems: NICE guideline","volume":"64","author":"O'flynn","year":"2014","journal-title":"Br J Gen Pract."},{"key":"B56","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1093\/humrep\/dev135","article-title":"Salpingostomy in the treatment of hydrosalpinx: a systematic review and meta-analysis","volume":"30","author":"Chu","year":"2015","journal-title":"Hum Reprod."},{"key":"B57","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.bpobgyn.2019.01.011","article-title":"Hydrosalpinx - salpingostomy, salpingectomy or tubal occlusion","volume":"59","author":"Ng","year":"2019","journal-title":"Best Pract Res Clin Obstet Gynaecol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1537506\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T04:10:43Z","timestamp":1745554243000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1537506\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":57,"alternative-id":["10.3389\/fmed.2025.1537506"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1537506","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]},"article-number":"1537506"}}