Reevaluation of hysterosalpingography in infertility investigation.

The hysterosalpingogram has been extensively used in infertility investigations to assess tubal patency, however, the diagnostic reliability of this technique is not known. Two hundred thirty-one consecutive hysterosalpingograms were retrospectively evaluated. Sixty-two percent (143) of the patients subsequently underwent laparoscopy. Comparison of hysterosalpingogram and laparoscopic findings revealed a 15.9% false positive tubal patency rate and a 14.9% false negative tubal patency rate. Seventy-six percent of laparoscopies revealed previously undiagnosed intraperitoneal disease. Seventeen percent of hysterosalpingograms demonstrated intrauterine pathology. There was a 0.9% major complication rate with hysterosalpingograms due to two cases of acute pelvic inflammatory disease. No significant laparoscopic complications were noted. The results suggest that laparoscopy provides a more accurate assessment of tubal patency and peritoneal factors than hysterosalpingogram in the investigation of infertility.