A Large Study About Reproductive Factors That Predict Hysterosalpingography-Identified Tubal Pathology: An Insight into the Necessity of Preconception Screening

<b>Background/Objectives</b>: Hysterosalpingography (HSG) is pivotal in delineating tubal pathology, but is associated with pain and exposure to ionizing radiation. This study investigated which reproductive factors predict HSG-identified tubal pathology. <b>Methods</b>: From May 2016 to August 2023, 3322 infertile females with HSG (mean age 33.9 ± 4.3 years) were assessed for fallopian tube status. <b>Results</b>: HSG indicated that 2764 had patent tubes while 558 (16.8%) had non-patent tubes. Unilateral and bilateral absence of free contrast spillage occurred in 377 (11.3%) and 181 (5.4%) cases, respectively. Non-spillage, denoted as non-patency, was seen in 148 (4.5%) and 153 (4.6%) right and left cases, respectively. Tubal occlusion was observed in 181 (5.4%) and 159 (5.4%) right and left cases, respectively. Hydrosalpinx was found in 37 (1.2%) right and 58 (1.7%) left cases. Multivariate logistic regression revealed CT-IgG positivity (odds ratio [OR]: 1.57), endometrioma (OR: 1.64), and fibroids (OR: 1.58) as independent factors for increased non-patency. CT-IgG positivity (OR: 1.92) and fibroids (OR: 1.88) were significant risk factors for occlusion. Painful defecation (OR: 2.79), CT-IgA positivity (OR: 2.09), CT-IgG positivity (OR: 2.07), and endometrioma (OR: 3.11) were significant risk factors for hydrosalpinx. <b>Conclusions</b>: In females with painful defecation, CT-IgG positivity, endometrioma, and fibroids, HSG may be used as a second-line investigation, with laparoscopy as the preferred assessment tool.