The accuracy of hysterosalpingogram in the diagnosis of tubal blockage among sub-fertile women at the Kenyatta National Hospital, Nairobi

Abstract

Background: Tubal factor accounts for 22% of cases of subfertility among women. The diagnosis of tubal
infertility can be made using either hysterosalpingogram (HSG) or laparoscopy.
Objective: To determine the accuracy of using HSG in diagnosing fallopian tube blockade with  laparoscopy as the gold standard.
Design: Prospective observational study.
Setting: Kenyatta National Hospital.
Methods: An observational study at the Kenyatta National Hospital (KNH). The main outcome measures
were; proportion correctly diagnosed to have proximal and distal blockage on HSG; proportion of patients
correctly diagnosed to have adhesions and proportion of patients correctly diagnosed to have  hydrosalpinx. Correlation was undertaken using the chi-square test and the agreement between the two tests compared, using the laparoscopy dye test as the gold standard. Likelihood ratios and predictive values were used to test for accuracy of HSG compared to laparoscopy.
Results: Hysterosalpingogram could accurately detect tubal blockage with a sensitivity of 74% and a
specificity of 70%. Its sensitivity in detecting tubal adhesions was 17.9% with a specificity of 85.7%; and 80% sensitivity and specificity of 76% for hydrosalpinx
Conclusion: HSG has a high specificity in diagnosing tubal occlusion and hydrosalpinx but of low value in
detecting tubal adhesions.

Keywords: Hysterosalpingogram (HSG), Laparoscopy, Infertility, Fallopian tubes, Adhesions