Comparative Evaluation of HSG and Diagnostic Hystero-Laparoscopy in Female Subfertility and Their Impact on Natural Conception Rates and Detection of Pelvic and Tubal Pathologies .

Original Article

Abstract

Objective: To evaluate the diagnostic performance of hysterosalpingography for detecting tubal pathology using diagnostic hystero-laparoscopy with chromopertubation as the reference standard and to assess the association of tubal and pelvic findings with subsequent natural conception.

Methodology: This comparative Cross sectional study was conducted in the Department of Obstetrics and Gynaecology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Punjab, Pakistan, from June 2025 to May 2026.180 women with primary or secondary subfertility and HSG was performed during the early proliferative phase of the menstrual cycle using 10–15 mL of water-soluble iodinated contrast medium under fluoroscopic guidance. Diagnostic hystero-laparoscopy was subsequently performed during the follicular phase, generally within 2–4 weeks of HSG, under general anesthesia. Tubal patency was assessed laparoscopically by chromopertubation using diluted methylene blue dye. HSG was the index test, and hystero-laparoscopy with chromopertubation was the reference standard. We recorded pelvic abnormalities identified during laparoscopy separately and did not consider them mutually exclusive. We followed participants for six months after completing the diagnostic evaluation to document natural conception.

Results: Most participants were aged 26–30 years (36.67%), and 56.67% had primary subfertility. HSG showed 70.91% sensitivity, 74.29% specificity, and 72.22% diagnostic accuracy for tubal pathology. Pelvic adhesions (32.22%) were most common. Natural conception occurred in 35.56% during six months, with higher rates among women with normal tubal findings.

Conclusion: Hystero-laparoscopy is more accurate for diagnosis and more useful for prognosis for natural conception than HSG in female subfertility.