Role of hysterosalpingography and diagnostic laparoscopy in infertility

Parminder Kaur Sachdeva, Navdeep Kaur


Background: Infertility is one of the commonest problems encountered in gynecology. Improved familiarity with and access to infertility services among the affluent and better educated patients probably accounts for their greater use of the medical resources. The two most important diagnostic procedures which are used for evaluation of infertility are hysterosalpingography (HSG) and laparoscopy.

Methods: The present study was conducted on 50 patients with infertility after meeting inclusion criteria in the Department of Obstetrics and Gynaecology and Department of Radio-diagnosis, in Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala over a period of 18 months. All the patients were examined by HSG as part of their routine infertility evaluation, three months after HSG, status were assessed by laparoscopy. All the data collected were presented in terms of frequencies and percentage. Chi-square and p value were calculated in excel. P <0.05 was considered statistically significant.

Results: The study included 50 female patients with infertility. Among them 34 (68%) patients belonged to primary infertility and 16 (32%) belongs to secondary infertility. 58% of patients were in the age group between 20-25 years, 28% in between 26-30 and 14% with age above 30 years. Maximum number of cases 29 (58%) had duration of infertility between 1-5 years. Of the 50 patients, 31 cases had normal HSG findings and 19 cases had abnormal findings. 15 patients were dropped from the study during the period of laparoscopy. On laparoscopy 7 (20%) patients were observed with uterine abnormalities, 15 (43%) with tubal factors, 10 (29%) with ovarian defects, 7 (20%) with peritoneal factors and 4 (11%) with unknown etiology. On HSG and laparoscopy 7 patients had shown some complications.

Conclusions: Although laparoscopy is a superior method of detection of tubal and pelvic pathologies in the evaluation of infertility, HSG is more economical, highly sensitive and elementary method, suitable for evaluation of endometrial and tubal pathologies. These two methods are not alternative but are complimentary techniques.


Infertility, Hysterosalpingography, Laparoscopy

Full Text:



Male and Female Infertility Just Keeps on 'Rising'. By Express News Service. Chennai Published: 27th January 2014.

Berek JS, Rinehart RD, Hillard PA, Adashi Ey. Operative Gynecology. In: Novak's Gynecology. 14th edition. Philadelphia: Lippincott Williams and Wilkins; 2007: 979-83.

Inhorn MC. Global infertility and the globalization of new reproductive technologies: illustrations from Egypt. Soc Sci Med. 2003;56(9):1837–51.

Jaffe SB, Jewelewicz R. The basic infertility investigations. Fertil steril. 1991;56:599-613.

Mosher WD, Prati WF. Fecundibility and infertility in the United States: incidence and trends. Fertil Steril. 1991;56:192-3.

Serafini P, Batzofin J. Diagnosis of female infertility. A comprehensive approach. J Reprod Med. 1989;34:29–40.

Tsuji I, Ami K, Fujinami N, Hoshiai H. The significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by hysterosalpingography. Tohoku J Exp Med. 2012;227(2):105–8.

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.

Simpson WL Jr, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. Radiographics. 2006;26(2):419–31.

Schankath AC, Fasching N, Urech-Ruh C, Hohl MK, Kubik-Huch RA. Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings. Insights Imaging. 2012;3:475–83.

Tvarijonaviciene E, Nadisauskiene RJ. The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients. Medicina (Kaunas). 2008;44(6):439–48.

Aral SO, Cates W Jr. The increasing concern with infertility, why now? Science. 1983;250:2327.

Chimote A, Samal S, Hariharan C, Angik R. Laparoscopy and hysteroscopy in patients of infertility in a rural set up. Int J Reprod Contracept Obstet Gynecol. 2015;4(2):322-8.

García-Ulloa AC, Arrieta O. Tubal occlusion causing infertility due to an excessive inflammatory response in patients with predisposition for keloid formation. Med Hypotheses. 2005;65(5):908-14.

Tomassetti C, Meuleman C, Pexsters A, Mihalyi A, Kyama C, Simsa P, et al. Endometriosis, recurrent miscarriage and implantation failure: is there an immunological link? Reprod Biomed Online. 2006;13:58–64.

Wasiu Eniola O, Adebayo Adetola A, Taiwo Abayomi B. A review of Female Infertility; important etiological factors and management. J Microbiol Biotech Res. 2012;2(3):379-85.

Barbieri RL. The initial fertility consultation: recommendations concerning cigarette smoking, body mass index, and alcohol and caffeine consumption. Am J Obstet Gynecol. 2001;185(5):1168–73.

Wheeles CR, Katayama KP. Laproscopy and Tubal Sterilization. In: John A, Thompson A, editors. Te Linde’s Operative Gynecology. 6th edition. Philadelphia (PA): JB Lippincot; 1985: 411.

Saini VK, Patel SC, Kawad K. Role of Diagnostic Laparoscopy in Infertility-Study of 50 cases. Int J Sci Res. 2013;2(7):290-2.

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

Sortey KD, Dhurandhar J. Laparoscopic evaluation of infertility. J Obstet Gynaecol India. 1989;39:809-11.

Agarwal M, Anand NI. Laparoscopy in Infertility. Int J Biol Med Res. 2014;5(1):3865-8.

Dorr PJ, De Craen AJM, Helmerhorst FM. Routine use of Hysterosalpingography prior to laparoscopy in the fertility workup. A multicenter randomized controlled trial. Hum Reprod. 2006;21(5):1227-316.

Sharma R. Laparoscopic evaluation of cases of primary and secondary infertility. J Obs Gynec India. 1997;47(4):366-71.

Siegler AM. Evaluation of tubal factors in infertility and management of tubal obstruction. Clin Obstet Gynecol. 1979;22(1):81-99.

Chakraborti DK, Kole SK. Diagnostic laparoscopy in gynaecologic disorders. J Obstet Gynaecol. 1990;40:262-5.

Bhide AG. Laparoscopic evaluation of the etiopathology of infertility. J Obs Gyn India. 1990;40:680-2.

Coltart TM. Laparoscopy in the diagnosis of tubal patency. J Obst Gynecol Br C Wealth. 1970;77:69-71.

Samal S, Agrawal S, Agrawal M. Role of laparoscopy in infertility in a rural setup hospital. Int J Repord Contracept Obstet GynecoL. 2014;3(1):185-8.