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CARS Archives

HSG of Limited Value in Fertility Evaluation
Title: Radionucleotide hysterosalpingography is not predictive in the diagnosis of infertility
Author: Lundberg S. et al.
Address: Stockholm, Sweden
Source: Fertility and Sterility 69: 216-220(February)1998
Summary: This retrospective analysis investigates whether hysterosalpingography (HSG) is predictive in the diagnosis of infertility. 175 women underwent HSG between April 1986 and April 1993. Using data collected from questionnaire inquiring about pregnancy, the occurrence of pregnancy related to outcome of radionucleotide HSG and its test properties were calculated. 129 women demonstrated bilateral or unilateral tubal transport with HSG. 66 (51%) of these women became pregnant, of these pregnant women, 36 55%)had successful infertility treatments and 30(455) reported spontaneous pregnancy. 46 women demonstrated no tubal transport using HSG, of these women, 25 (54%) became pregnant, 14 (56%)with infertility treatment and 11 (44%) spontaneously. Predictive values of HSG with transport and without was 0.51 and 0,46 respectively. Pregnancy liklihood outcomes for those with tubal transport and those with no transport were 1.03 and 0.93 respectively. The authors offer that these values demonstrate that HSG is not able to predict fertility potential.
Comment: I question the use of HSG as a general screening test. However, it may have value for answering a specific question. It has little value in the diagnosis of endometriosis, a common cause of pelvic adhesive disease, or conditions where adhesions may impair fertility but not obstruct the tubes. HSG is quite good for the determination of major congenital anomalies, but then, we are left with whether or not to treat the findings. Commonly reported false positive and false negative rates are around 20%. The largest objection is that it Ôhurts like hellÕ and is really quite costly given the information obtained. We all will continue to do a few of these tests, but use of HSG in early routine evaluation of infertility should be questioned.

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