To assess the clinical value of four-dimensional hysterosalpingography (TVS-4D-HyCoSy) in pre-pregnancy screening with assisted reproductive technology.

A retrospective analysis was performed on 678 infertility patients who planned to undergo assisted reproductive technology procedures at Wuxi Maternity and Child Health Hospital from March 2016 to June 2019. A total of 1338 fallopian tubes in 678 patients underwent TVS-4D-HyCoSy. All cases underwent laparoscopic examination with methylene blue solution after operation, of whom 177 underwent hysteroscopy and treatment. The diagnostic efficacy of TVS-4D-HyCoSy on tubal patency and uterine cavity lesions was calculated, and its consistency with hysteroscopy was analyzed using Kappa test.

With the results of laparoscopic examination with methylene blue solution as the diagnostic gold standard, the coincidence rates of TVS-4D-HyCoSy in diagnosing patency, partial patency, and obstruction of fallopian tubes were 93.64% (663/708), 82.95% (321/387), and 91.89% (204/222), respectively. The two methods were more consistent in the diagnosis of tubal patency (Kappa value=0.812). Among 678 patients, TVS-4D-HyCoSy diagnosed uterine malformations and uterine cavity abnormalities in 285 cases (285/678, 42.04%). Taking the hysteroscopic diagnosis results of 177 patients as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional ultrasound and positive contrast agents in the diagnosis of uterine cavity abnormalities were 40.00%, 22.03%, 88.89, 6.25%, and 44.44%, and 62.96%, 60.00%, 94.44%, 13.04%, and 31.09%, respectively; the corresponding values of negative contrast agents in the diagnosis of uterine cavity abnormalities were 98.15%, 80.00%, 98.15%, 80.00%, and 48.31%. Only negative contrast media and hysteroscopy were consistent in the diagnosis of uterine cavity abnormalities (Kappa value = 0.781).

TVS-4D-HyCoSy can accurately determine the patency of the fallopian tube, and also has important diagnostic value for uterine malformations and intrauterine lesions. It can be used as an effective and comprehensive method for pre-pregnancy screening with assisted reproductive technology.