Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings.
OBJECTIVE
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.


CONCLUSIONS
• 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?
Institute of Radiology, Kantonsspital Baden AG, 5404, Baden, Switzerland.
Adrian C
AC
Schankath
Nikola
N
Fasching
Cornelia
C
Urech-Ruh
Michael K
MK
Hohl
Rahel A
RA
Kubik-Huch