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

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.