Accuracy of hysterosalpingography and hysteroscopy for diagnosis of intrauterine lesions in infertile patients in an assisted fertilization programme

Objective To determine the accuracy of hysterosalpingography compared with hysteroscopy for detection of intrauterine abnormalities in infertile patients. Design Cross-sectional study. Setting University hospital. Subjects 296 women undergoing an assisted fertilization programme. Intervention Patients Underwent to hysteroscopy and hysterosalpingography prior to intrauterine insemination or in vitro fertilization. Main outcome measures Hysterosalpingographic and hysteroscopic findings. Results Hysteroscopy proved satisfactory in 90.5% of cases. Of the patients, 121 (40.9%) had an abnormal hysteroscopic evaluation. The most prevalent hysteroscopic findings were: cervical stenosis (n = 28); chronic endometritis (n = 17); synechiae (n = 16); suspected endometrial hyperplasia (n = 14); polyps (n = 11); and myomas (n = 7). The comparison of hysteroscopic and hysterosalpingographic findings revealed a sensitivity of 75.21% and a specificity of 41.14% for hysterosalpingography; the positive and negative predictive values were 47% and 70.60%, respectively. Conclusions Hysterosalpingography is not sufficiently accurate, with regard to specificity or sensitivity, for screening pathologies of the endometrial cavity in infertile patients. Hysteroscopy should be performed in all patients before IVF and artificial insemination.