Comparative Analysis of Hysterosalpingography and Diagnostic Hysteroscopy Findings in Infertility Evaluation

Introduction Infertility affects most of the women of reproductive age, with uterine and tubal factors contributing significantly. Hysterosalpingography (HSG) and diagnostic hysteroscopy are widely used modalities in infertility evaluation. This study compares the findings of HSG and hysteroscopy to assess their diagnostic accuracy and utility in clinical management. Materials and methods A retrospective comparative observational study was conducted at Adichunchungiri Hospital, Karnataka, over six months (April-September 2024). Thirty-nine women aged 23-36 years with primary or secondary infertility underwent both HSG and diagnostic hysteroscopy. HSG assessed tubal patency and gross uterine abnormalities, while hysteroscopy provided direct visualization of intrauterine pathologies. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), with hysteroscopy considered the gold standard for intrauterine pathology. Results Bilateral tubal patency was observed in 59% of cases on both HSG and hysteroscopy. HSG demonstrated a sensitivity of 95.83% and specificity of 92.31% for tubal patency. However, hysteroscopy detected additional findings like hydrosalpinx (10.26%), fimbrial cysts (5.13%), and uterine adhesions (7.69%), which were missed by HSG. For uterine abnormalities, HSG had a sensitivity of 70% and specificity of 85.71%, while hysteroscopy provided superior detection of fibroids and septate uterus. Notably, hysteroscopy influenced management decisions, guiding surgical interventions or assisted reproductive techniques in selected cases. Conclusion While HSG remains effective for screening tubal patency, diagnostic hysteroscopy offers superior detection of intrauterine pathologies, impacting treatment strategies. Combining both modalities enhances diagnostic accuracy in infertility evaluation.