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 Table of Contents  
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 111-113

A retrospective study on role of HSG in evaluation of female infertility

1 Department of Reproductive Medicine, IGIMS, Patna, Bihar, India
2 Department of Radiology, IGIMS, Patna, Bihar, India

Date of Submission11-Jan-2021
Date of Decision29-Jun-2021
Date of Acceptance21-Sep-2021
Date of Web Publication17-Aug-2021

Correspondence Address:
Kalpana Singh
Department of Reproductive Medicine, IGIMS, Sheikhpura, Patna - 800 014, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jigims.jigims_10_21

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Aims and Objectives: Hysterosalpingogram (HSG) is one of the investigations used to evaluate female infertility. The objective of this study was to assess the role of HSG in evaluation of female infertility.
Materials and Methods: A retrospective study conducted at IGIMS, Patna. The data collected were the infertile patients in whom HSG procedure performed among the women attending between November 2016 and November 2018 were included.
Results: The study included a total of 130 cases of infertile women, in which 70% of cases were of primary infertility and 30% were of secondary infertility. About 83% of cases were of normal tubes with bilateral spillage.
Conclusion: The retrospective study showed that HSG is a safe, lesser invasive, and cost effective and a valuable diagnostic procedure.

Keywords: Fallopian tubes, hysterosalpingogram (HSG), infertility

How to cite this article:
Nishat H, Singh K, Tiwary B, Kumari S, Shashi K, Kumari M. A retrospective study on role of HSG in evaluation of female infertility. J Indira Gandhi Inst Med Sci 2021;7:111-3

How to cite this URL:
Nishat H, Singh K, Tiwary B, Kumari S, Shashi K, Kumari M. A retrospective study on role of HSG in evaluation of female infertility. J Indira Gandhi Inst Med Sci [serial online] 2021 [cited 2022 Nov 28];7:111-3. Available from: http://www.jigims.co.in/text.asp?2021/7/2/111/331740

  Introduction Top

Infertility in the society is associated with vital medical, psychological, and socioeconomic problems.[1] The WHO reports infertility as a global health issue.[2] The worldwide prevalence of infertility defined as failure to conceive after more than 12 months of unprotected intercourse is around 8%–12%.[3],[4],[5] Primary infertility is defined as patient had never been pregnant whereas secondary infertility is the inability to conceive following a previous pregnancy which may or may not have led to live birth.[6] There are many factors of infertility, and the common causes of infertility include male factor, ovulation disorders, and tubal factor. Tubal factor is one of common causes of female infertility in about 25%–35% of female infertility.[7],[8] Tubal function can be damaged by infection or due to any surgery. Tubes can be damaged in the proximal, mid, or distal portion. Contraindications for HSG are pregnancy, PID, bleeding per vaginum. There are various tests to evaluate tubal patency. Hysterosalpingography (HSG) is one of the diagnostic tests to evaluate tubal patency. HSG has a sensitivity of 85%–100% in identifying tubal occlusion.[8],[9]

The basic role of HSG is to evaluate the patency and morphology of the fallopian tubes. HSG is also helpful in the evaluation of uterine cavity abnormalities.

  Materials and Methods Top

This is a retrospective study which includes all infertile female patients between ages of 18 and 39 years, who came in the outpatient department of the Reproductive Medicine department in IGIMS, Patna, from November 2016 to November 2018. Patients whose radiographs were not traceable were excluded. The biodata and indications for the investigations and the HSG findings were obtained. The total number of patients included were interpreted by visualization of X-ray films checking for unilateral and bilateral spillage of contrast medium into the pelvis.

HSG technique

The HSG was performed at the Radiology Department of our institute. The procedure was performed between day 6 and day 10 of the menstrual cycle (day 1 being the 1st day of the last menstrual period). This is because the endometrium was thin during this proliferative phase. A scout film of the pelvis was taken to assess proper positioning and radiopaque pelvic lesions. Under aseptic condition with the help of vaginal speculum, the anterior lip was held with a vulsellum forceps. Leech-Wilkinson uterine cannula was inserted into the endocervical canal. The contrast medium was injected slowly into the uterine cavity. Before injecting the media, it is to be made sure that there were no air bubbles in the media. There are 3 more spot films during the time of early uterine filling, tubal filling, and peritoneal spill.

  Results Top

Out of 130 patients, 70% of patients were of primary infertility and 30% were of secondary infertility [Table 1]. Most patients fell in to 1 to 5 years duration of infertility [Table 2]. Most of the patients were of age group between 26 to 30 years [Table 3]. 83% patients had normal tubes with bilateral spillage [Table 4]. 93.8% patients had normal shape of uterus, in 2% of patients had unicornuate uterus and 8% had bicornuate uterus [Table 5].
Table 1: Incidence of patients with type of infertility

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Table 2: Duration of infertility

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Table 3: Incidence of infertility according to age of patients

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Table 4: Tubal findings and peritoneal spillage

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Table 5: Uterine cavity finding

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  Discussion Top

There has been in increase in number of women attending fertility clinic during the past decade for infertility evaluation.[8],[10] Hence, it is to be taken into account that the management of these cases should be less invasive as possible. HSG is simple, less invasive, and cost effective. This study gives the wide range of available information and advantages of HSG which can be extremely useful in the diagnosis and management of infertile patients.[11] In our study, patients with primary infertility were 70% and secondary infertility was 30%. Our study is comparable to the incidence in the study conducted by Saini et al.[12] About 83% of total patients had bilateral patent tubes and spillage seen which is similar to study of Kumari TM et al.[13]

  Conclusion Top

This study suggests that HSG is a safe, lesser invasive, and cost effective, especially in a developing country like ours. As known laparoscopy is the gold standard in the diagnosis of tubal patency, HSG should be the first investigation in the diagnosis of infertility which gives important information about uterine cavity as well as fallopian tubes.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Greil AL, Blevins KS, McQuillan J. The experience of infertility: A review of recent literature. Social Health Illn. 2010;32:140-162.  Back to cited text no. 1
Boivin J, Bunting L, Collins JA , Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007;22:1506-12.  Back to cited text no. 2
Inhorn MC. Global infertility and the globalization of new reproductive technologies: Illustrations from Egypt. Soc Sci Med 2003;56:1837-51.  Back to cited text no. 3
Sotrel G. Is surgical repair of the fallopian tubes ever appropriate? Rev Obstet Gynecol 2009;2:176-85.  Back to cited text no. 4
Dun EC, Nezhat CH. Tubal factor infertility: Diagnosis and management in the era of assisted reproductive technology. Obstet Gynecol Clin North Am 2012;39:551-66.  Back to cited text no. 5
Abubakar AP, Yusuf TS. The profile of infertility in a teaching hospital in North West Ngeria. Sahel Med J 2014;17:7-11.  Back to cited text no. 6
Serafini P, Batzofin J. Diagnosis of female infertility. A comprehensive approach. J Reprod Med 1989;34:29-40.  Back to cited text no. 7
Sachdeva PK, Kaur N. A retrospective study on role of HSG in evaluation of female infertility. Int J Reprod Contracept Obstet Gynecol 2016;5:3743-9. Available from: https:\\www.ijrcog.org. [Last accessed on 2016 Nov].  Back to cited text no. 8
Berek JS, Rinehart RD, Hillard PA, Adashi EY. Textbook of Gynaecology. 14th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 979-83.  Back to cited text no. 9
Aral SO, Cates W Jr. The increasing concern with infertility. Why now? JAMA 1983;250:2327-31.  Back to cited text no. 10
Karasick S. Hysterosalpingography. Urol Radiol 1991;13:67-73.  Back to cited text no. 11
Saini VK, Patel SC, Kawad K. Role of diagnostic laparoscopy in infertility in infertility study of 50 cases. Int J Sci Res 2013;2:290-2.  Back to cited text no. 12
Kumari TM, Swetha A, Sangabathula H. A study on role of HSG in evaluation of female infertility. Int J Contemp Med Surg Radiol 2017;2:164-6.  Back to cited text no. 13


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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