HYSTEROSALPINGOGRAPHY

Objective: To assess the diagnostic accuracy of Hysterosalpingographyin determining tubal patency in cases of sub fertility. Design: Prospective analytical study. Setting: Department ofGynaecology and obstetric Combined Military Hospital Multan in collaboration with Radiology department. Population:One hundred sub fertile women in their reproductive age having sub-fertility greater than 36 months or less than it, ifmaternal age was greater than thirty years or there was history of pelvic pain or abnormal pelvic findings. Period: May2003 – April 2004. Material & Methods: One hundred patients underwent Hysterosalpingography in follicular phasefollowed by laparoscopic chromopertubation in secretory phase in next cycle. Results: Hysterosalpingography andlaparoscopy were successfully performed in 100% of cases. Full concordant findings from two procedures wereobtained in 80% of cases for tubal blockade. Evaluation of clinical efficacy of Hysterosalpingography regarding tubalpatency showed a sensitivity of 91%, specificity 74.2% with positive predictive value 64.5% and negative predictivevalue 94%. On the other hand a low sensitivity of Hysterosalpingography was obtained regarding peri-tubal adhesions.Both the procedures were free of major complications. Incidence of minor complication was 17% for laparoscopy and18% for Hysterosalpingography. Conclusion: Because of high sensitivity, Positive Predictive Value and reasonablygood concordance rate of Hysterosalpingography with laparoscopy, it should remain an integral part of female subfertilitywork-up. Although it cannot replace laparoscopy but it can be used as first line screening investigation of tubalpatency irrespective of duration of sub-fertility.