Hysterosalpingography in the workup of female infertility: Indications, technique and diagnostic findings

Abstract

Objectives: To evaluate the spectrum of diagnostic findings in hysterosalpingography (HSG) examinations performed at our institution between 2006-2010 and their prognostic significance for treatment decisions and fertility outcomes. Methods: Patients were filtered from our PACS. Pathological HSG studies were re-evaluated. Indications for referral, technical success and diagnostic findings were analysed. Pathological findings were correlated with further diagnostic workups, treatments and fertility outcomes. Results: Of 411 HSG examinations, 226 (55 %) were normal, 94 (23 %) showed minor abnormalities and 5 (1. 2 %) were not diagnostic. Eighty-six (21 %) examinations were pathological. Twenty-nine patients underwent subsequent laparoscopy, during which proximal tubal occlusion diagnosed at HSG was ruled out in 9/23 cases. Follow-up information was unavailable for 20 patients. Nineteen of 66 patients with follow-ups after pathological HSG had at least one subsequent successful pregnancy. Forty-one patients had no further treatment and no pregnancies. Conclusions: The detection rate for pathologies at HSG was low (21 %). There was a high false-positive rate (39 %) for proximal tubal occlusion, most likely because of spasms, demonstrating the importance of delayed imaging after injection of antiperistaltic agents. HSG remains a valuable diagnostic tool. Our results, however, indicate that this technique should be more selectively indicated. Main Messages: • Good acceptance of HSG by the patients. No complications with antibiotic prophylaxis.• Low detection rate (21 % pathological exams) for pathologies in our study.• High false-positive rate for proximal tubal occlusion.• This demonstrates the importance of waiting longer after injection of buscopan.• High pregnancy rate in pathological cases: Indication too broad or even a therapeutic effect of HSG? © 2012 The Author(s).