How to perform and interpret a hysterosalpingography

The search for tubal patency is mandatory when investigating an infertile couple; a hysterosalpingography (HSG) is the first and least invasive diagnostic test. A laparoscopic dye test with general anesthesia is performed only when a preceding test suggests pathology (e.g., positive chlamydia serology). In all other circumstances, HSG is more convenient, rapid, and nearly painless if gently executed. This article details the technical aspects of the examination and provides assistance in image interpretation. A HSG is indicated just after menstruation to avoid the risk of irradiation during a possible pregnancy. A negative bacterial smear confirms there is no risk of iatrogenic infection. Iodine allergy requires premedication. Sensitivity and specificity are good for the diagnosis of tubal patency, but interpretation of uterine or tubal details should not be over-read because of the test's low specificity. Nevertheless, HSG remains a first-choice test.