A second hysterosalpingography reduces the use of selective technique for treatment of a proximal tubal obstruction

Objective: To assess whether a second hysterosalpingography (HSG) can permi t tubal patency, reducing the use of selective salpingography in patients w ith proximal tubal obstruction. Design: Prospective study. Setting: University hospital. Patient(s): The study population consisted of 360 infertile women. Intervention(s): In patients with unilateral or bilateral proximal tubal ob struction, a second HSG was performed after about 1 month. In those cases w ith persistent obstruction, an immediate selective salpingography and tubal catheterization were performed. Main Outcome Measure(s): Tubal opacification. Result(s): Forty patients underwent a second HSG procedure for proximal tub al occlusion. Among these, 24 achieved bilateral tubal patency. Thus, repet ition of a conventional HSG after 1 month avoided unnecessary salpingograph y in 60% of patients. Conclusion(s): In infertile women with proximal tubal obstruction, we belie ve it is best to perform a second HSG. HSG is easy to carry out and subject s patients to a lower dosage of radiation and fewer risks than selective sa lpingography. The latter technique should be reserved for unsuccessful case s. (Fertil Steril(R) 2000; 73:1037-9. (C) 2000 by American Society for Repr oductive Medicine).