Infertile couples with a normal hysterosalpingogram: Reproductive outcome and its relationship to clinical and laparoscopic findings

The purpose of this study was to retrospectively investigate the clinical course of infertile couples following a normal hysterosalpingogram (HSG) to determine the reproductive outcome and assess the diagnostic value of subsequent laparoscopy (LSC). The infertile couples (N = 132) were aged 29 ± 0.5 SD years, with 3.2 ± 0.4 years of infertility, and were followed for an average of 17 ± 1.5 months after the HSG. Twenty-nine percent of patients became pregnant after a normal HSG performed with water-soluble contrast medium. There was a fourfold greater rate of pregnancy during the first three months after a normal HSG than during any other three-month interval up to one year. Thirty-four of the initial 132 patients required laparoscopy because of failure to conceive or suspected pelvic disease based on symptoms or the results of a pelvic examination. Among the 34 patients receiving LSC, pelvic pathology was found in 19 (56%). Corrective surgery and/or a change in therapy occurred in 60% of cases after LSC. There was an increased proportion of abnormal findings with increasing time intervals between HSG and LSC but not with increasing intervals of infertility before HSG. Abnormal uterine bleeding was predictive of abnormalities at LSC, while prior use of oral contraceptives correlated negatively with pelvic pathology. In women in infertile couples who have a normal HSG: (1) LSC should not be performed before three months after a normal HSG because of the potential therapeutic effect of HSG, (2) LSC should be performed after a normal HSG if pregnancy has not occurred by at least one year because of the high incidence of pelvic pathology, and (3) HSG using water-soluble contrast media has a therapeutic effect comparable to that described for oil-soluble contrast media.