HYSTEROSCOPY, HYSTEROSALPINGOGRAPHY AND TUBAL OSTIAL POLYPS IN INFERTILITY PATIENTS

OBJECTIVE: To compare the findings in infertility patients who underwe nt preoperative hysterosalpingography (HSG) followed by hysteroscopy a nd to determine the incidence of tubal ostial polyps, their HSG appear ance and the results of hysteroscopic resection in our patient populat ion. STUDY DESIGN: Sixty eight infertility patients were evaluated by HSG followed by hysteroscopy. HSG diagnoses were divided into groups: group 1, normal; group 2, bilateral tubal occlusion; group 3, unilater al tubal occlusion; group 4, filling defects; and group 5, abnormal ca vity. HSG findings were compared to the hysteroscopy findings. For pat ients in whom tubal ostial polyps were found, the findings were descri bed, including postsurgical interval to conception. RESULTS: The agree ment rates were 90%, 50%, 69%, 73% and 71% for groups 1-5, respectivel y The positive predictive value of an abnormal HSG was 65%, and the ne gative predictive value of a normal HSG was 90%. Six of 68 patients (1 1.3%) had polyps at the fallopian tube ostium. Three of these patients (50%) had had the finding of proximal tubal occlusion on the ipsilate ral side predicted by HSG; three had had normal HSGs. Four Of the six conceived following polypectomy. The mean interval from surgery to con ception was 4.5 months. CONCLUSION: HSG was a specific but not sensiti ve predictor of uterine pathology in our patient population. Tubal ost ial polyps may occur in a significant proportion of infertility patien ts and can cause proximal tubal occlusion on HSG. Their possible contr ibution to infertility and clinical significance deserve further inves tigation.