Radionuclide hysterosalpindography is not predictive in the diagnosis of infertility

Abstract Objective : To investigate whether radionuclide hysterosalpingography (radionuclide HSG), which has been suggested as a more functional approach to the diagnosis of tubal infertility than conventional patency tests, is predictive in the diagnosis of infertility. Design : A retrospective analysis of data from an inquiry form containing questions about pregnancy outcome after radionuclide HSG. Setting : University hospital-based, tertiary care infertility clinic. Patient(s) : Two hundred sixteen women had an infertility work-up including radionuclide HSG performed between April 1986 and April 1993. Forty-one (18.9%) women were excluded from the study; 9 had moved to unknown addresses, 16 did not answer the inquiry, and 16 gave answers that were not interpretable. There were 175 (81.1%) women in the final study group. Intervention(s) : An inquiry form containing questions regarding pregnancy was sent to 207 women who had undergone radionuclide HSG as a routine procedure in their infertility workup. Main Outcome Measure(s) : Occurrence of pregnancy related to outcome of radionuclide HSG and its test properties calculated. Result(s) : Bilateral or unilateral tubal transport was demonstrated by radionuclide HSG in 129 women, of whom 66 (51%) later became pregnant. Of the pregnant women, 36 (55%) had successful infertility treatment, whereas 30 (45%) reported spontaneous pregnancy. Forty-six women showed no transport at radionuclide HSG. Twenty-five (54%) of these women became pregnant, 14 (56%) with infertility treatment and 11 (44%) without infertility treatment. The predictive values of transport and no transport radionuclide HSG were 0.51 and 0.46, respectively. The sensitivity of radionuclide HSG was 0.25, and the sensitivity was 0.73. Likelihood ratios for pregnancy when radionuclide HSG showed transport and no transport were 1.03 and 0.93, respectively. Conclusion(s) : Our data strongly indicate that a single radionuclide HSG investigation is not able to predict fertility potential.