Comparison of hysterosalpingography and hysteroscopy in the evaluation of the uterine cavity in patients undergoing assisted reproductive techniques.

OBJECTIVE: To investigate the diagnostic value of hysterosalpingography (HSG) for intracavitary and structural uterine pathologies in comparison with hysteroscopy (HS) in patients undergoing intracytoplasmic sperm injection-embryo transfer and also to specify the patients who should be subjected to HS in the early stages of an infertility work-up.

DESIGN: Retrospective analysis.

SETTING: IVF unit of a university hospital.

PATIENT(S): Three hundred fifty-nine consecutive women who underwent both HSG and HS for infertility investigation.

INTERVENTION(S): HS and HSG.

MAIN OUTCOME MEASURE(S): HS findings.

RESULT(S): HSG shows a sensitivity of 21.56%, specificity of 83.76%, positive predictive value of 55.26%, and negative predictive value of 70.75%. Its false-negative rate is 78.43%, and its false-positive rate is 16.23%. Overall agreement between the two procedures is 68.9%. The risk of abnormal HS increases with advancing patient age and duration of infertility. Risk increments associated with patient age over 35 years and increasing number of previous assisted reproductive techniques (ART) persist even in the presence of a normal HSG. As expected, we encounter significantly less abnormal HS in the male factor infertility group.

CONCLUSION(S): HS should be performed especially in patients older than 35 years of age and/or with a history of two or more previous ART trials even in the presence of a normal HSG. HSG shows unconvincing diagnostic value for intracavitary and structural uterine pathologies in infertility evaluation.