{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:22:52Z","timestamp":1791390172015,"version":"4.3.3"},"reference-count":43,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Tubal dysfunction may be a contributing factor in up to 35% of infertility cases, rendering tubal patency assessment a vital component of the infertility workup. In this review we examined the diagnostic efficacy and tolerability of hysterosalpingo-foam sonography (HyFoSy) and compared it to hysterosalpingography (HSG) and hysterosalpingo-contrast sonography (HyCoSy). Methods: Online databases were systematically searched and evaluated according to the PRISMA 2020 guidelines. Statistical heterogeneity was assessed. Diagnostic sensitivity, specificity and inter-method agreement were evaluated, along with mean pain scores. Results: This analysis included data from 9 studies and 1354 patients with conclusive diagnostic data from 2422 tubes and 1294 patients with data on intra-procedural pain. With regard to HyFoSy and HyCoSy comparison, pooled sensitivity was 87% and 69%, respectively (p = 0.074), while pooled specificity was 95% and 85%, respectively, favoring HyFoSy (p &lt; 0.001). HyFoSy was more tolerable with regard to pain, but this was not statistically significant. Regarding the HyFoSy and HSG comparison, pooled Cohen\u2019s k was 0.38, indicating fair-moderate agreement. In subsequent analysis, with HSG as a reference standard, HyFoSy demonstrated low sensitivity (61%) but high specificity (87%). With regard to experienced pain, HyFoSy and HSG had a difference of 2.4 units on a 10-point scale, favoring HyFoSy (p &lt; 0.001). Conclusions: HyFoSy was superior to HyCoSy and may be used as a first-line tubal assessment method, with HSG being utilized in inconclusive cases. However, further research is still required due to the small number of available studies.<\/jats:p>","DOI":"10.3390\/medsci13030168","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T15:02:57Z","timestamp":1756825377000},"page":"168","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of HyFoSy, HyCoSy and X-Ray Hysterosalpingography in the Assessment of Tubal Patency in Women with Infertility: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8961-7709","authenticated-orcid":false,"given":"Emmanouil M.","family":"Xydias","sequence":"first","affiliation":[{"name":"EmbryoClinic IVF, 6 Andrianoupoleos, 55133 Thessaloniki, Greece"},{"name":"School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, AUTH Campus, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2837-4691","authenticated-orcid":false,"given":"Vasileios","family":"Emmanouil","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Medicine, Democritus University of Thrace, Alexandroupoli Campus, 68100 Alexandroupoli, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1976-3780","authenticated-orcid":false,"given":"Maria","family":"Koutini","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Medicine, Democritus University of Thrace, Alexandroupoli Campus, 68100 Alexandroupoli, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6665-6545","authenticated-orcid":false,"given":"Anna","family":"Ntanika","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Faculty of Medicine, University of Ioannina, Doroutis Campus, 45110 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0972-2133","authenticated-orcid":false,"given":"Elias","family":"Tsakos","sequence":"additional","affiliation":[{"name":"EmbryoClinic IVF, 6 Andrianoupoleos, 55133 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2129-1073","authenticated-orcid":false,"given":"Matthew","family":"Prior","sequence":"additional","affiliation":[{"name":"Newcastle Fertility Centre, International Centre for Life, Department of Reproductive Medicine, Times Square, Newcastle upon Tyne NE1 4EP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8912-5920","authenticated-orcid":false,"given":"Ippokratis","family":"Sarris","sequence":"additional","affiliation":[{"name":"King\u2019s Fertility Centre, The Fetal Medicine Research Institute, 16-20 Windsor Walk Denmark Hill, London SE5 8BB, UK"},{"name":"Faculty of Life Sciences & Medicine, Department of Women\u2019s and Children\u2019s Health, King\u2019s College, Strand Campus, London WC2R 2LS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6665-0167","authenticated-orcid":false,"given":"Ioannis","family":"Thanasas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, General Hospital of Trikala, 56 Karditsis, 42131 Trikala, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7300-9514","authenticated-orcid":false,"given":"Alexandros","family":"Daponte","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Faculty of Medicine, University of Thessaly, 3 Panepistimiou, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3377-6935","authenticated-orcid":false,"given":"Apostolos C.","family":"Ziogas","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Faculty of Medicine, University of Thessaly, 3 Panepistimiou, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.clinbiochem.2018.03.012","article-title":"Fertility and infertility: Definition and epidemiology","volume":"62","author":"Wyns","year":"2018","journal-title":"Clin. 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