HYSTEROSCOPY IS SUPERIOR TO HYSTEROSALPINGOGRAPHY IN INFERTILITY INVESTIGATION

Background. The development of advanced endoscopic instrumentation in recent years has demonstrated the superiority of direct visual examina tion over radiographic demonstration of various body cavities. Just as laparoscopy has gradually taken a primary role in the surgical invest igation of the ovulatory infertile patient, the role of intrauterine e ndoscopy in comparison to hysterosalpingography (HSG) needs to be reev aluated. Methods: Four hundred and sixty-four infertile women had unde rgone both hysterosalpingography and a diagnostic hysteroscopy and che findings were analysed. Results. Compared to hysteroscopy the sensiti vity of HSG was 98%, but its specificity only 15%, the positive predic tive value 45%, and negative predictive value 95%. On hysteroscopy a n ormal uterine cavity was found in 53% of the cases with a filling defe ct and in 56% of those with uterine wall irregularity on HSG. Conclusi ons. Hysteroscopy, a safe and rapid direct visualisation of the uterin e cavity is superior to HSG in the identification of intrauterine path ology. In view of the low positive predictive value and the low specif icity of the HSG. we believe it should be replaced by the diagnostic h ysteroscopy as a first line infertility investigation.