Evaluation of the role of the hystrosalpingography in prediction of endometriosis in infertile females

Tamer H. Said, Gehan Shehata


Background: Hysterosalpingography is the testing the patency of the tubes and the uterine cavity by injecting urographin inside them. The purpose in this study was to evaluate 2 signs in hysterosalpingography (higher position of one or both tubes and S or C shape in the course of one or both tubes) in prediction of endometriosis. 

Methods: This was prospective cohort study that was done in El-Shatby Maternity University Hospital, Alexandria University. The study included eighty six infertile women who were assigned to do laparoscopy.  Recent hysterosalpingography was done within 3 months period before laparoscopy and comments were done on the position and S or C shape in the course of the tube then laparoscopy was done and document all findings including presence of endometriosis and biopsy was taken from atypical lesions.

Results: All signs show high specificity in prediction of endometriosis although only 2 signs (higher level of left tube and bilateral tubal S or C shape) showed significantly high sensitivity in prediction of endometriosis.

Conclusion: Careful examination of the HSG film and searching for the specific signs of endometriosis is a practical and simple method in prediction of endometriosis. These preliminary data suggest that HSG has a role in prediction of endometriosis.


Hysterosalpingography, Tube, Prediction, Endometriosis

Full Text:



Revised American Society for Reproductive Medicine Clssification of Endoetriosis: 1996. Fert Steril. 1997;67:817-821.

D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003;21:243-54.

Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. Br J Obstet Gynaecol. 2004;111:1204-12.

Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20:2698-704.

Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil And Steril J. 2009;92,1:86-74.

Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24:235-38.

Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K. MR imaging of disorders associated with female infertility: use in diagnosis, treatment, and management. Radio Graphics. 2003;23:1401-21.

Simpson WL, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. Radio Graphics. 2006;26:419-31.

Schenken RS, Guzick DS. Revised American Fertility Society. Classification- 1996. Fertility and Sterilit. 1997;67(5):815-6.

Bacevac J, Ganovic R. (Diagnosic value of hystrosalpingography in examination of fallopian tubes in infertile women) Srp Arh Celok Lek. 2001;129(9-10):243-6.

Vasiljević M, Ganović R, Jovanović R, Marković A. (Diagnostic value of hystrosalpingography and laparoscopy in infertile women). Srp Arh Celok Lek. 1996;124(5-6):135-8.

Streda R, Mardesic T, Kult D, Lazarovska S, Slamova J, Voboril J. The diagnostic value of hystrosalpingography in the diagnosis of tubal disease. Ceska Gynekol. 2009;74(1):18-21.

Jill A. Steinkeler, Courtney A. Woodfield, Elizabeth Lazarus, Mary M. Hillstorm, Female Infertility: A Systematic Approach to Radiologic Imaging and Diagnosis. Radiographics. 2009;29:1353-70.

Coimbra H, Pereira HS, Real FC, Sampaio MG, Lagarto R, Falcão F, et al. Hysterosalpingography in the diagnosis of pelvic endometriosis. Acta Med Port. 2000;13(5-6):255-8.

Johnson WK, Ott DJ, Chen MY, Fayez JA, Gelfand DW. Efficacy of hystrosalpingography in evaluating endometriosis. Abdom Imaging. 1994;19(3)278-80.

Coimbra H, Pereira HS, Real FC, Sampaio MG, Lagarto R, Falcao F, et al. Hystrosalpingography in the diagnosis of pelvic endometrosis. Acta Med Port. 2000;13(5-6):255-8.

Goynumer G, Yetim G, Gokcen O. Is in Karaaslan, Lale Wetherilt, Birol Durukan. Hystrosalpingograhy, Laparoscopy or both in the diagnosis of Tubal Disease in Infertility. World Journal of laparoscopic Surgery. 2008;1(2):23-6.

Duraker R, Demir B, Dilabaz B, Akkurt O, Kocak M, Tasci Y, et al. Comparison between hystrosalpingograpgy and laparoscopy results in the diagnosis of tubal occlusion. J Turk Soc Obstet Gynecol. 2011;8,1:40-3.

Al-Fozan H, Tulandi T. Left lateral predisposition of endometriosis and endoemtrioma. Obstet Gynecol. 2003;101(1):164-6.

Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility. Am Fam Physician. 2015;91(5):308-14.

Liberty G, Hyman J, Friedler S, Anteby EY, Margalioth EJ. High rates of abnormalities in hysterosalpingography in couples with male factor infertility.Clin Exp Obstet Gynecol. 2014;41(4):415-8.

Szymusik I, Grzechocińska B, Marianowski P, Kaczyński B, Wielgoś M. Factors influencing the severity of pain during hysterosalpingography. Int J Gynaecol Obstet. 2015;129(2):118-22.

Altinbas KS, Dilbaz B, Zengin T, Kilic S, Cakir L, Sengul O, et al. Evaluation of pain during hysterosalpingography with the use of balloon catheter vs metal cannula. J Obstet Gynaecol. 2015;35(2):193-8.

Ibekwe PC, Udensi AM, Imo AO. Hysterosalpingographic findings in patients with infertility in South eastern Nigeria. Niger J Med. 2010;19(2):165-7.

Fatnassi R, Kaabia O, Laadhari S, Briki R, Dimassi Z, Bibi M, et al. Interest of laparoscopy in infertile couple with normal hysterosalpingography Gynecol Obstet Fertil. 2014;42(1):20-6.

Tshabu-Aguemon C, Ogoudjobi M, Obossou A, King V, Takpara I Alihonou E. Hysterosalpingograpgy and laparocscopy in evaaulattion of thee fallopian tubes in management of infertility in Cotonou, benin Republic. J West Afr Coll Surg. 2014;4(2):66-75.