Hysterosalpingography in Uterine and Tubal Factor Subfertility - An Outdated Procedure or a Reemergent Study?

Abstract

Objective: to determine frequency of various abnormalities detected on hysterosalpingography in patients presenting with subfertility.

Study Design: Descriptive / cross-sectional study

Place and Duration of Study: This study was conducted at the Department of Obstet. and Gynae, Noshera Medical College, Noshera. from October 2013 to March 2014.

Materials and Methods: This study involved 318 patients presenting to outpatient Gynae clinic of Northwest General Hospital and Research Hospital, Peshawar with primary or secondary infertility of at least one year.  After initial history, examination  and consent, HSG was performed using set criteria and the films reported by consultant radiologist.

Results: Mean age of the patients was 29.6 years with 25-36 years being the commonest age group. 58.5% patients had primary infertility whereas 41.5% patients had secondary infertility. Majority of the patients (84%) had normal HSG whereas only 16% showed some abnormality. The abnormalities detected on HSG included Tubal block ( 13.8%...unilateral:9.4%%; bilateral:4.4%), Hydrosalpinx (2.5%....unilateral:2.5%; bilateral:0.6%), Peritubal adhessions(1.6%) and uterine abnormalities (2.8%). The most frequent uterine abnormality was bicornuate uterus (1.6%) which was more common in primary infertility patients, followed by submucous fibroid/ polyp (0.6%).  Proximal tubal block was more common than distal tubal block.

Conclusion: The majority of patients in this study had normal HSG and most of these can be spared  laparoscopy, given the high specificity of HSG for tubal patency. Therefore, HSG is still the 1^st line investigation in the workup of tubal factor for infertility.