Transvaginal 4D Ultrasound for Reducing Venous Intravasation in Hysterosalpingo Contrast Sonography: A Comparative Study

This retrospective comparative study aimed to assess the value of painless transvaginal four-dimensional hysterosalpingo contrast sonography (TV 4-D HyCoSy) in reducing venous intravasation and its influencing factors, compared to conventional TV 4-D HyCoSy. A total of 451 patients were included, with 249 in the painless group and 202 in the conventional group, between January 2019 and October 2021. The study analyzed the incidence of venous intravasation, its related factors, and the ease of diagnostic evaluation. The results indicated that the incidence of venous intravasation was significantly lower in the painless TV 4-D HyCoSy group (16.9%) compared to the conventional group (24.8%), with a p-value of 0.039. Painless TV 4-D HyCoSy proved particularly effective in reducing venous intravasation in patients with primary infertility (p = 0.032) and those without a history of pelvic surgery (p = 0.008) or ectopic pregnancy (p = 0.018). Logistic regression analysis revealed that painless TV 4-D HyCoSy and endometrial thickness greater than 5 mm were protective factors against venous intravasation. Moreover, the diagnostic process was easier in the painless group (p = 0.002), suggesting that it provides a more comfortable and efficient experience for patients. These findings suggest that painless TV 4-D HyCoSy can significantly reduce venous intravasation while improving the diagnostic accuracy of fallopian tube patency. By improving both patient comfort and diagnostic outcomes, painless TV 4-D HyCoSy offers a promising approach in fertility assessments, especially for those without significant gynecological history, and could potentially become the preferred method in clinical practice.