Open AccessShould a hysterosalpingogram be a first-line investigation to diagnose female tubal subfertility in the modern subfertility workup?
Author(s) -
Chou Pay Lim,
Zaid Hasafa,
Siladitya Bhattacharya,
Abha Maheshwari
Publication year - 2011
Publication title -
human reproduction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.446
H-Index - 226
eISSN - 1460-2350
pISSN - 0268-1161
DOI - 10.1093/humrep/der046
Subject(s) - hysterosalpingography , gold standard (test) , infertility , medicine , laparoscopy , gynecology , hydrosalpinx , fertility , diagnostic test , chlamydia , obstetrics , radiology , biology , pregnancy , population , pediatrics , environmental health , immunology , genetics
Tubal assessment is an integral part of female fertility evaluation. While diagnostic laparoscopy is gold standard, it is not suitable to be used as a screening test. Hysterosalpingogram (HSG) has been advocated as first-line investigation historically. With advances in diagnostics, more tests are available, such as hysterosalpingo contrast sonography (HyCoSy) and Chlamydia antibody titre (CAT) are available. The CAT test is much cheaper, less invasive and can be performed at any time during the cycle. The CAT test can also be used as a means of identifying which patients need further evaluation. HyCoSy has same diagnostic accuracy as HSG, without exposing women to radiation. We argue that HSG is out of date and has no place in a modern infertility evaluation. We also suggest a pathway (based on history, clinical and ultrasound evaluation) for investigations to screen for and diagnose tubal pathology.