The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients

Abstract

Background and objective Hysterosalpingography (HSG) is a common radiologic modality employed for the initial workup of female infertile patients to evaluate for tubal patency or any gross intrauterine pathology. HSG is a relatively cheap and easily available outpatient procedure but bears the risk of radiation exposure. The purpose of the study was to compare the diagnostic value of HSG with that of diagnostic hysterolaparoscopy in infertile women and to evaluate their role in the diagnosis and management of infertility. Methodology This study was carried out from February 2018 to January 2019. All women attending our outpatient department (OPD) for the treatment of infertility who were aged between 20-40 years were included in the study. Those with acute vaginal and cervical infection and those having an allergic reaction to the dye used in HSG were excluded from the study. Known cases of pelvic inflammatory disease and those who achieved pregnancy before the performance of hysteroscopy were also excluded from the study. Results A total of 172 women with primary or secondary infertility were enrolled in the study. Out of these, 13 women became pregnant, and two were lost to follow-up and were excluded from our study. Thus, a total of 157 infertile women were analysed. The agreement between HSG and hysteroscopy was 71.3% for the evaluation of the uterine cavity, and this was considered a fair strength of agreement between the procedures (k value=0.302). Conclusion Compared to HSG, the incidental findings detected by hysteroscopy amounted to 19.14%. Our study results depict the advantage of hysterolaparoscopy over HSG. Although the sensitivity of HSG is as good as that of diagnostic hysterolaparoscopy for the detection of tubal patency, a significant number of important incidental findings can be missed by it. Hence, diagnostic hysterolaparoscopy should be offered as the first-line modality for the evaluation of infertility wherever the procedure is available.

Hysteroscopy is Gold standard in Uterine evaluation for Infertility, but HSG still has a place

“…In our study, the strength of agreement between hysteroscopy and hysterosalpingography is moderate (Kappa =0.505) while the same in Panda et al 17 study was fair (k value=0.302) and in Ahmed et al 21 study ranged from moderate to good (K=0.49-0.79). Hafizi L et al 18 and Taskin et al, 22 reported an agreement rate of 68.9% between the two.…”

“…Wadhwa et al 13 too reported common abnormality as filling defects in 15 (14.28%) women followed by congenital uterine anomaly in five women, bicornuate uterus in four, and arcuate uterus in one woman whereas uterine filling defects were seen in 78 (31.2%) cases in Onwuchekwa et al 19 study. Panda et al 17 too observed filling defect as most common in 10.8% followed by irregular cavity in 7.64%, bicornuate uterus in 5.73 %, arcuate uterus in 1.27% and small cavity in 2.54 %.…”

The categorization of opaque pathologies outside of contrast media in hysterosalpingography which facilitate interpretation: A pictorial review

“…Hysterosalpingography (HSG) is a roentgenological visualization of the inner surface of the cervical canal, uterine isthmus, uterine cavity, and fallopian tubes. It is an inexpensive and non-invasive procedure (4). Not only is it a reliable method for the assessment of fallopian tube patency, but also it can detect intrauterine pathologies and some pelvic pathologies outside of contrast areas (5).…”