The role of hysterosalpingography in the evaluation of infertility.

Hysterosalpingography is the only radiologic procedure routinely performed in the initial evaluation of the infertile woman. Hysterosalpingography is used to assess the anatomy of the uterus and the patency of the fallopian tubes, and is performed in the proliferative phase of the menstrual cycle. It can be performed with either water- or oil-soluble contrast medium. Care should be taken during the procedure that excessive amounts of contrast medium are not injected, because that could obscure the diagnostic findings. Selective salpingography can help evaluate a suspected proximal tubal occlusion. The complications associated with hysterosalpingography include pain, pelvic infection, intravasation of contrast medium and allergic reactions. Abnormal hysterosalpingographic findings include occlusion of one or both fallopian tubes, uterine filling defects and müllerian anomalies. Therapy for abnormal hysterosalpingographic findings depends on the specific clinical scenario and includes endoscopic surgery, laparotomy and in vitro fertilization.