Uterine and tubal anatomical abnormalities in infertile women: diagnosis with routine hysterosalpingography prior to selective laparoscopy.

Objective. To assess the findings and usefulness of hysterosalpingography (HSG) as a routine investigation in the fertility workup prior to selective laparoscopy. Design. Descriptive retrospective study. Setting. A university hospital in the north of Jordan. Subjects. All patients who underwent hysterosalpingography in the period 1 January - 31 December 2008. Outcome measures. Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings. Results. During the study period, 281 infertile women underwent HSG with no post-procedural complications. The mean (SD) age was 31.5 (5.9) years. Mean (SD) duration of infertility was 4 (3.4) years. Infertility was reported as primary and secondary in 119 (42.3%) and 162 (57.6%), respectively. Altogether, 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. In only one woman were peritubal adhesions diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4%) were referred for laparoscopy. Eight (17.3%) of them were treated with unilateral salpingectomy, and 28 (60.8%) with bilateral salpingectomy. Salpingolysis was performed on 7 (15.2%) women; 3 (6.7%) women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61%, and the positive predictive value 71%. Of the total of 281 women, 30 (10.7%) conceived within 1 - 11 months after HSG. Conclusion. The very high abnormal predictive value of HSG in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination. [ABSTRACT FROM AUTHOR]