Hysterosalpingography in the investigation of women requesting reversal of sterilization. Should it play a role?

Objective: To evaluate the role of hysterosalpingography (HSG) in the investigation of women requesting reversal of sterilization (ROS).

Study Design: A prospective, cohort study at a university-affiliated, tertiary fertility clinic. All women proceeding to surgery were investigated with HSG in addition to other routine screening. Findings from HSG were tabulated to document the prevalence of abnormalities and correlated with histologic findings in resected tubal segments.

Results: One hundred sixteen women of 166 referred for ROS underwent HSG during the initial evaluation. HSG depicted abnormal tubal images in only 2 cases (1.7%) and abnormal uterine images in 15 (12.9%) cases. In the cases of abnormal tubal findings, there was no association with histologic findings. The specificity of HSG as a diagnostic screening tool was 90%; however, the small number of cases with abnormal histology prevented calculation of an accurate estimate of sensitivity of HSG as an investigative tool before ROS. A less invasive method of imaging the uterus, such as a vaginal ultrasound, may provide more valuable information in evaluating the future fertility outcome in these women.

Conclusion: The prevalence of abnormalities of the proximal oviductal segment identified by HSG is too low to warrant the routine use of HSG as a diagnostic tool.