The validity of HSG in infertility work up

Abstract

Background: Our purpose was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the diagnosis of the uterine cavity and tuboperitoneal abnormalities in infertile women. Reproducibility and consistency were also assessed. Two hundred infertile females underwent HSG, hysteroscopy, and/or laparoscopy as part of infertility workup. HSG examinations were retrospectively reviewed by three radiologists; we compared interobserver variability, and differences between the two results of reading the same examination after 3 months were compared to calculate intraobserver variability. HSG sensitivity, specificity, PPV, NPV, and accuracy were calculated. Results: The overall accuracy of HSG in diagnosing tubal, uterine cavity, and peritoneal abnormalities was 95.5%, 95%, and 89%, respectively (P value < 0.04). HSG is reproducible in diagnosing normal versus abnormal examinations. Reproducibility in diagnosing uterine cavity, tubal, and peritoneal abnormalities was (ICC = 0.90), (ICC = 0.70), and (ICC = 0.31), respectively. Best agreement was seen in diagnosing luminal filling defect (sub mucous fibroid/polyp) (ICC = 0.90) (95% CI 0.86-0.98), whereas poorest agreement was found in diagnosing uterine adhesions (ICC = 0.13) (95% CI 0.10-0.13) and pelvic adhesions (ICC = 0.12) (95% CI 0.10-0.13) (P value < 0.03). HSG consistency ranged from moderate to good (K = 0.49-0.79). It was highest in diagnosing normal versus abnormal examination (P value < 0.01); poorest in diagnosing pelvic adhesions. Conclusion: HSG has high validity in negative results; it can minimize the use of invasive procedures. Laparoscopy is recommended in patients who had a pelvic disease or showing tubal obstruction on HSG.

In response to the article “The relationship between hysterosalpingography findings and female infertility in a Nigerian population”. Pol J Radiol 2020; 85: e188-e195

“…Another observation that the authors made was that tubal pathology was more common than other pathologies in infertile patients. This could partly be explained by the fact that HSG is inherently less sensitive in detecting ovarian, uterine, or cervical pathologies [ 3 ]. Hence one cannot draw conclusions based on the findings of HSG, and it should be confirmed with a cheap and simple investigation like transvaginal ultrasound.…”

Hysterolaparoscopy in assessment and management of female infertility

“…Visualization of the uterine cavity to detect any existing pathology emphasized the importance of hysteroscopy in the diagnostic evaluation of female infertility. Hysteroscopy can help resolve ovary morphology, tubal patency, tubal morphology, disorders of the uterine cavity, and pelvic pathology in a single session [3] . The laparoscopic intervention has added advantages of hemostasis, less pain, precise surgery, less cost, and better tissue handling compared to the conventional approach.…”