Is Hysterosalpingography Still Relevant in Modern-day Female Infertility Work-up? A Review

Abstract

Hysterosalpingography (HSG), a radiologic procedure used to study the cavity of uterus and fallopian tubes is one of the oldest and most widely used imaging modalities in the evaluation of female infertility. Over time there have been discovery and application of more modern radiologic modalities like ultrasound-based and magnetic resonance (MR) imaging techniques such as, three-dimensional / four-dimensional transvaginal ultrasound (3D/4D-TVUS), saline infusion sonohysterography(SIS), hysterosalpingo-contrast sonography (HyCoSy), hysterosalpingo-foam sonography (HyFoSy), and MR-hysterosalpingography (MR-HSG) for the same purpose. The application of these recent imaging options has challenged the relevance and justification for continuing the use of HSG in infertility work-up. Thus, this review seeks to find out the ongoing relevance or otherwise of HSG in contemporary infertility work-up. In this process, the comparative diagnostic and therapeutic value of HSG, its relative safety and invasiveness, as well as its cost effectiveness and accessibility, are put in perspective with the newer modalities. The outcome shows that despite the new discoveries and the advancements achieved in modern imaging, HSG continues to play important roles in female fertility work-up as it remains relevant in assessing tubal patency and internal uterine morphology. Its accessibility, standardization, and cost-effectiveness make it near indispensable, especially in resource-limited clime. It complements rather than competes with the newer technologies.