Objective This study describes the examination procedure and clinical outcomes of hysterosalpingo-contrast sonography (HyCoSy) with perflubutane used as the ultrasound contrast agent for tubal patency evaluation. Methods Infertile women who attended our clinic between May and December 2023 were assessed. HyCoSy using perflubutane (Sonazoid®) was performed between the end of menstruation and ovulation, after confirmation of the absence of bacterial vaginosis and chlamydia infection. Following insertion of an 8-Fr balloon catheter into the uterine cavity, a diluted perflubutane contrast was slowly infused under transvaginal ultrasonographic guidance. Tubal patency and intraperitoneal spillage was evaluated using color Doppler imaging. Thereafter, clinical characteristics, adverse events, and pregnancy outcomes up to December 2024 were retrospectively analyzed using medical records. Results A total of 100 patients underwent HyCoSy using perflubutane between May and December 2023. Of them, 94 had confirmed bilateral tubal patency; 5, unilateral patency; and 1, bilateral tubal occlusion. One patient experienced mild abdominal pain during the procedure; no other adverse events occurred. Among the 90 patients who were followed after the examination, 24 achieved pregnancies through timed intercourse, 7 through intrauterine insemination, and 32 through in vitro fertilization. Conclusions HyCoSy using perflubutane is a safe, simple, and effective method for tubal patency evaluation that does not involve radiation exposure or pose iodine-related risks. This technique may serve as a valuable alternative to conventional hysterosalpingography for the initial evaluation of infertile women.
