Reply: 'One-stop shop' ultrasound evaluation of an infertile patient: doing less is no longer an option.

Sir,

We thank Dr Melcer and Dr Maymon for their interest in our article. Dr Melcer and Dr Maymon comment that our study results need to be seen as just one part of the comprehensive ‘one-stop shop’ fertility work-up in infertile couples (Melcer and Maymon, 2022). We agree that hysterosalpingo-foam sonography (HyFoSy) is not the only part of the work-up. Indeed, other features, such as uterine polyps, submucous myomas, uterine anomalies and intrauterine adhesions can also be visualized, although their prognostic and therapeutic impact is largely unclear.

We want to stress that our study does not take into account the direct therapeutic effect of tubal flushing. Recent studies showed a fertility-enhancing effect of tubal flushing during hysterosalpingography with oil-based contrast, resulting in higher pregnancy and live birth rates (Dreyer ; Fang ; Wang ; Wang ). Direct therapeutic effects of tubal flushing using HyFoSy versus other types of contrast are still to be assessed.

Funding

The FOAM study was an investigator-initiated study funded by ZonMw, the Netherlands organization for Health Research and Development (project number 837001504). ZonMw funded the whole project. IQ Medical Ventures provided the ExEm-foam® kits free of charge. The funders had no role in study design, collection, analysis and interpretation of the data. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Conflict of interest

K.D. reports travel and speaker fees from Guerbet. B.W.J.M. reports grants from National Health and Medical Research Council (NHMRC). B.W.M. reports consultancy for Guerbet and research funding from Merck and Guerbet. V.M. reports non-financial support from IQ medicals ventures, during the conduct of the study; grants and personal fees from Guerbet, outside the submitted work; and his department receives research grants from Ferring and Merck, outside the submitted work. The other authors do not report conflicts of interest.