THE PREDICTIVE VALUE OF HYSTEROSALPINGOGRAPHY FOR TUBAL AND PERITONEAL INFERTILITY FACTORS

Objective: To investigate a practical classification system of hystero salpingogram (HSG) results that accurately identifies patients with se vere pelvic disease or a normal pelvis to allow appropriate patient co unseling of therapeutic options. Design: Retrospective chart review fr om university teaching hospital. Hysterosalpingography results were cl assified as normal, abnormal (bilateral distal tubal obstruction), or suspicious (all others). At surgery, chromopertubation was performed, and pelvic disease was documented. Results: From a total of 756 patien ts, HSGs were confirmed surgically in 96.6% of normals, 63.1% of suspi cious, and 95.7% of abnormal. Associated moderate-severe pelvic diseas e was found in 16.2% of normals, 53.9% of suspicious, and 81.7% of abn ormal. Conclusion: Abnormal HSGs are highly predictive of severe pelvi c disease, and counseling of treatment options does not require diagno stic laparoscopy. Patients with suspicious HSGs frequently have normal tubes but also have a significant likelihood of tubal or associated p elvic disease, and they are responsible for the poor predictive value of the HSG. This group of patients requires confirmatory laparoscopy p referably by a physician qualified in pelviscopic surgery. Normal HSGs have a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to w arrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful .