Abstract
Introduction: Tubal and uterine pathologies are recognized as the leading anatomic contributors to female infertility in many low‑ and middle‑income countries. Where diagnostic laparoscopy is not readily accessible, hysterosalpingography (HSG) retains prominence as the first‑line imaging test.
Objective: To determine the frequency, pattern and predictors of structural abnormalities detected on HSG among infertile women at a tertiary care hospital in Peshawar, Pakistan, and to compare findings between primary and secondary infertility.
Methods: We performed a descriptive cross‑sectional study from January to June 2024. A total of 196 married women aged 18–40 years, presenting with at least 12 months of primary or secondary infertility, underwent standardized HSG between menstrual cycle days 6–11. Two independent radiologists interpreted the images; disagreements were resolved by consensus. Demographic, clinical and radiologic variables were analyzed using SPSS 26. Chi‑square and Fisher’s exact tests assessed associations; binary logistic regression explored predictors of tubal pathology.
Results: Mean age was 28.8 ± 6.2 years; the predominant age band was 26–30 years (41.3%). Secondary infertility accounted for 71.4% of cases. Overall, 52/196 (26.5%) HSGs were abnormal. Tubal pathology predominated (42/196, 21.4%): unilateral blockage 20.9% (left 11.2%, right 9.7%) and bilateral blockage 0.5%. Hydrosalpinx occurred in 3.1%. Uterine abnormalities comprised 4.6% mainly congenital malformations (unicornuate 1.5%, arcuate 1.0%, bicornuate 0.5%) and submucosal fibroid 0.5%. Tubal pathology was significantly more frequent in secondary than primary infertility (adjusted OR = 1.96, 95% CI 1.07–3.59, p = .03). Age, parity and body‑mass index were not significant predictors.
Conclusion: Approximately one quarter of infertile women demonstrated structural abnormalities on HSG, with unilateral tubal occlusion being the principal lesion. The strong link between secondary infertility and tubal disease underscores the need for early infection prevention and prompt postpartum care. Where laparoscopy is unavailable, HSG remains indispensable for triaging patients to tubal recanalization or assisted reproduction.