Is hysterosalpingography an important tool in predicting fertility outcome?

Objective: To determine the prognostic significance of hysterosalpingography (HSG) for fertility outcome. Design: Retrospective cohort study. Setting: Infertility department of an academic hospital. Patient(s): Consecutive patients undergoing HSG for subfertility between May 1985 and November 1987. Intervention(s): Hysterosalpingography. Main Outcome Measure(s): Follow-up ended when pregnancy or tubal surgery occurred or at the day of last contact. Kaplan-Meier curves for the occurrence of spontaneous intrauterine pregnancy (IUP) were constructed for a normal HSG, a HSG with a one-sided abnormality, and a HSG with a two-sided abnormality. Fecundity rate ratios were calculated to express the association between HSG findings and the occurrence of spontaneous IUP. Result(s): Of 359 patients that were analyzed, 231 (64%) showed no tubal pathology on HSG, 67 (19%) had a one-sided tubal pathology, and 61 (17%) had a two-sided tubal pathology. The adjusted fecundity rate ratios were 0.81 (95% confidence interval 0.47 to 1.4) for a one-sided pathology and 0.30 (95% confidence interval 0.13 to 0.71) for a two-sided pathology. Correction for informative censoring and sensitivity analysis did not alter these results. Conclusion(s): One-sided tubal pathology detected on HSG has limited prognostic significance, whereas two-sided tubal pathology detected on HSG reduces fertility prospects considerably.