Published: 2021-06-25

Diagnostic evaluation of tubal patency in a tertiary care hospital

Nikita Gandotra, Nivedita Prashar, Abhinav Sharma


Background: Infertility  has  always  been  one  of  the  most  elusive  symptom  complexes  that  perplex  the best gynecologists.  Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. Aim of the study was to compare hysterosalpingography and laparoscopy in the diagnosis of tubal patency in infertile patients.

Methods: In this study 50 patients of infertility were evaluated prospectively in the Department of Obstetrics and Gynecology, Government Medical College, Jammu from April 2019 to March 2020. The findings of HSG and laparoscopy were compared.

Results: Mean age at presentation for primary infertility was 28.6±4.20 years and for secondary infertility it was 32.1±3.84 years. Majority of patients of primary (77.6%) and secondary infertility (54.5%) had duration of infertility of 1-5 years in our study. The sensitivity of HSG was 90.91% and specificity was 77.78 % with positive predictive value of 83.33% and negative predictive value of 87.50%, when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided.

Conclusions: HSG demonstrates high sensitivity in our study. So, it should be used as the initial investigation for identifying tubal patency. As the specificity is less, we suggest that laparoscopy is necessary to recognize those cases of tubal block which were unrecognized or wrongly recognized on HSG. In addition, the patients who were found to have tubal block on HSG, laparoscopy helps in finding the cause of infertility like existence of peritubal adhesions and endometriosis that can guide appropriate therapy.


Hysterosalpingography, Infertility, Laparoscopy

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Jose Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Phys. 2007;75:849-56.

World Health Organization/ Manual for the standardized investigation and diagnosis of infertile couple. Cambridge, UK: Cambridge University Press, 2000.

Cheong YC, Li TC. Evidence based management of tubal disease and inferty. Curr Obst Gynaecol. 2005;15(5):306-13.

Balasch J. Investigation of infertile couple: investigation of infertile couple in the era of assisted reproductive technology. A time for reappraisal Hum Reprod. 2000;15:2251-57.

Laufer N, Simon A. Unexplained infertility: a reappraisal. Ass Reprod Rev. 1993;3:26-36.

Fertility Committee of RCOG Gynecological Laparoscopy. The report of the world party of the confidential enquiry into gynecological laparoscopy. 1992;126.

Back L. Looking forward: a profile of sexual and reproductive health in India: Population Council. Population Council. Infertility. 2004:67-72.

Berek JS. Bereks and Novaks Gynaecology. 15th ed. 2-21;1157.

Sakar MN, Gul T, Atay AE, Celik Y. Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women. Saudi Med J. 2008;29(9):1315-8..

Goynumer G, Yetim G, Gokcen O, Karaaslan I, Wetherilt L, Durukan B. Hysterosalpingography, laparoscopy or both in the diagnosis of tubal disease in infertility. World J Laparos Surg. 2008;1(2):23-6.

Hompes PG, Lambalk CB, Tanahatoe SJ. Investigation of the infertile couple: Should diagnostic laparoscopy be performed in infertility work up programme in patients undergoing IUI? Hum Reprod. 2003;18(1):8-11.

Corson S L, Cheng A, Gutmann J N. Laparoscopy in normal infertile patient: A question revisited. J Am Assoc Gynaecol Laparos. 2000;T:317-24.

Glatstein IZ, Sleeper LA, Lavy Y, Simon A, Am Adoni A, Palti Z, et al. Observer variability in the diagnosis and management of the hysterosalpingogram. Fert Ster. 1997;67(2):233-7.

Sharma R, Sharma V. The infertile woman: a study of 120 cases. J Indian Med Assoc. 1991;89(2):31.

Bossuyt PM, Mol BW, Swart P, Redekop WK, van Beurden, van der Veen F. The accuracy of hysterosalpingography in diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995;64:486-91.