RCOG World Congress 2025

Reducing the number of clinic attendances among patients seeking fertility treatment introducing 2D/4D HyCoSy service

Introduction/ the problem

With the trend of delaying fertility among couples, time is of the essence when couples come to seek fertility treatment. Once the woman reaches the age of 40, they are no longer eligible for government funded fertility treatment

Tubal patency test (2D HyCoSy/HSG) is traditionally arrange at the Department of Radiology.

Patients are required to attend an additional appointment afterwards to our gynaecology clinic for counselling on the results and subsequent fertility treatment.

Objective/Goal

The goal of the project is to reduces patients’ number of attendance to clinic and reduces time from diagnosis to treatment by introducing regular 2D/4D HyCoSy service in our ambulatory gynaecology unit

Method/the intervention

This is quality improvement project with prospective data collection, reviewing pre- and post-intervention data

The primary outcome is the number patients of who underwent counselling for treatment after HyCoSy at the same appointment

Balancing measures include the waiting time from booking to HyCoSy appointment, and procedural pain score

Results/Outcome Measures

•98 patient underwent HyCoSy during the period of 18/3/2023- 3/10/2024.

•1 case of failed procedure (patient was not able to tolerate speculum and uterine catheterization)

77/98 patients (78.6%) received counselling for fertility Treatment at the same appointment

- 6 cases: outpatient hysteroscopy for suspected endometrial polyp

- 3 cases booking Diagnostic Lap for suspected bilateral blocked tubes on HyCoSy

Remaining 23 cases (29.2%): 20 cases: the Husband did not submit semen for analysis before HyCoSy procedure, but the woman wished to proceed with HyCoSy

•1 case pending couple Hb pattern (subsequently found to be SEA Deletion Alpha Thalessemia Couple and referred for IVF + PGT)

•1 case pending all blood results

•1 case: newly diagnosed diabetes

Results/ Balancing Measures

•The waiting time from booking to HyCoSy procedure was similar pre- and post intervention

• (Average 42 days vs 49 days)

•The average pain score of the procedure using a visual analog scale was 4.5/10 ( range 0.7-8/10)

Next Steps

Couples should be reminded to submit relevant material to complete all other fertility related investigations before HyCoSy appointment, in order to facilitate the planning and timeline of fertility treatment

Conclusion

The introduction of regular HyCoSy Service in an ambulatory gynaecology unit reduces number of patient’s attendance to hospital, and is a well accepted procedure by patients

Acknowledgement

We would like to acknowledge our infertility Team nurses in our day ward for their support in data collection and intervention implementation

RCOG World Congress 2025

Reducing the number of clinic attendance among patients seeking fertility treatment

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