Comparing the Diagnostic Value of Hysterosalpingography with Hysteroscopy in Diagnosis of Uterine abnormalities in Infertile Women

Background & aim: Despite the identification of hysteroscopy as the most accurate method for the diagnosis of uterine cavity disorders, the patients are initially subjected to hysterosalpingography (HSG).  In this regard, the present study aimed to compare the diagnostic value of HSG and hysteroscopy in the detection of uterine cavity abnormalities in infertile women. Methods: This cross-sectional study was conducted on 91 infertile women who needed to undergo hysteroscopy in the Gynecology Ward of Imam Reza Hospital in Mashhad, Iran, due to the detection of a uterine abnormality in their HSG or failure of intrauterine insemination and in vitro fertilization during 2013 to 2014. The results of HSG and hysteroscopy to detect uterine cavity changes were compared. Data analysis was performed in SPSS software (version 16) using McNemar’s test. P-value less than 0.05 was considered statistically significant. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HSG were 38.78%, 78.57%, 67.86%, 52.38%, and 57.14%, respectively, in comparison to those of hysteroscopy. The results of the McNemar’s test revealed a significant difference between the results of HSG and hysteroscopy in the diagnosis of uterine cavity abnormalities (P=0.001). Conclusion: As the findings indicated, HSG had lower sensitivity, specificity, as well as positive and negative predictive values. Consequently, this method can be concluded as insufficient for the diagnosis of endometrial cavity disorders and incapable of diagnosing many factors affecting the outcome of infertility treatments. Therefore, all infertile women who are candidate for laparoscopy or those who need expensive infertility treatments are suggested to undergo hysteroscopy before the onset of treatment.