Observer variability in the diagnosis and management of the hysterosalpingogram

Benefit of Diagnostic Laparoscopy for Patients with Unexplained Infertility and Normal Hysterosalpingography Findings

“…Our findings are supported by previous studies which have reported that when diagnostic laparoscopy is performed for infertile patients with normal HSG findings, 21%-68% were shown to have pathologic abnormalities (Cundiff et al 1995;Belisle et al 1996;Badawi et al 1999;Corson et al 2000). Furthermore, considerable variability in the interpretation of HSG abnormalities and its clinical consequences have been reported among practitioners (Mol et al 1996;Glatstein et al 1997). In patients with unexplained infertility following standard infertility screening tests, diagnostic laparoscopy is the definitive step to visualize the pelvic cavity and determine the potential causes of infertility, which may include endometriosis and tubal disease.…”

The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients

“…Although only those films in which a technically adequate view of the uterus and tubes were included in our study, the results of Hofmann et al underline the importance of technical factors when performing and interpreting HSG films (23). This issue was discussed by the other authors (24)(25)(26)(27). Artefacts might include inadvertent insertion of the cannula, premature ending of the procedure, insufficient pressure because of vaginal reflux, or differences in muscle tonus of the tubes (4,27).…”

“…For these reasons the interpretation of HSG results might be biased due to variability among observers. Gladstein and coworkers estimated that interobserver reliability of the HSG varied from poor to fair (24). Overall, agreement among observers regarding the presence of an abnormal tubal pattern was fair and regarding adhesions only marginal (24).…”

“…Gladstein and coworkers estimated that interobserver reliability of the HSG varied from poor to fair (24). Overall, agreement among observers regarding the presence of an abnormal tubal pattern was fair and regarding adhesions only marginal (24). The other paper by Mol et al (27) analyzed interobserver as well as intra-observer reproducibility on four HSG items -proximal tubal obstruction, distal tubal obstruction, hydrosalpinx, and peritubal adhesions.…”

Evaluation of Cases of Secondary Infertility by Hysterosalpingography and Hysteroscopy

“…HSG is a safe, simple, inexpensive and rapid diagnostic test that can reveal the shape of the uterine cavity revealing an uterine abnormality in almost 25% of cases [1.2]. A large number of workers have reported a therapeutic role of HSG more evident with oil soluble than water soluble media [3][4][5][6][7]. Before the advent of hysteroscopy.…”