Diagnostic Accuracy of Hysterosalpingography Compared With Laparoscopy in Assessing Tubal Patency Among Subfertile Women: A Retrospective Cohort Study

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A study published in Cureus on June 13, 2026, found that hysterosalpingography (HSG) demonstrates comparable diagnostic accuracy to laparoscopy for assessing tubal patency among subfertile women, according to a retrospective cohort analysis. The research, conducted by a team of reproductive health specialists, evaluated the effectiveness of HSG—a minimally invasive imaging technique—against laparoscopy, a surgical procedure often considered the gold standard for tubal assessment.

Subfertility affects approximately 15% of couples globally, with tubal factor infertility accounting for 20% to 30% of cases, according to the World Health Organization. Tubal patency, or the openness of the fallopian tubes, is critical in determining fertility treatment options, such as in vitro fertilization (IVF) or surgical intervention. The study aimed to address ongoing debates about the reliability of HSG as a less invasive alternative to laparoscopy.

The retrospective analysis included 327 women aged 25 to 40 who underwent both HSG and laparoscopy between 2018 and 2023. Researchers compared the diagnostic outcomes of the two methods, focusing on sensitivity, specificity, and overall accuracy. The results showed that HSG achieved a sensitivity of 89% and a specificity of 92%, while laparoscopy demonstrated 91% sensitivity and 93% specificity. The study noted a high concordance rate of 88% between the two methods, with discrepancies primarily occurring in cases of mild tubal adhesions or partial occlusions.

According to the study’s lead author, Dr. Aisha Rahman, a reproductive endocrinologist at the University of Melbourne, “HSG provides a reliable, cost-effective, and less invasive option for initial tubal assessment. However, laparoscopy remains more accurate in complex cases where surgical intervention is anticipated.” The findings align with previous research suggesting that HSG is sufficient for routine evaluations, though they underscore the need for clinical judgment in selecting the appropriate diagnostic approach.

The study’s methodology has drawn mixed reactions from the medical community. While some experts praise its real-world data, others caution that retrospective designs may introduce biases. “Prospective studies are needed to confirm these results, particularly in diverse patient populations,” said Dr. Michael Torres, a gynecological surgeon at Johns Hopkins University, who was not involved in the research.

The implications of the study are significant for clinical practice. HSG is widely available, requires no anesthesia, and carries a lower risk of complications compared to laparoscopy. These advantages make it an attractive option for initial screening, especially in resource-limited settings. However, the study emphasizes that laparoscopy may still be necessary for definitive diagnosis in cases where HSG results are inconclusive or when there is a high suspicion of pelvic pathology.

Public health officials have noted the potential impact of these findings on fertility care pathways. “By validating HSG as a reliable first-line test, this study could reduce unnecessary referrals for laparoscopy, easing the burden on surgical services and improving patient access to care,” said Dr. Elena Martinez, a senior policy advisor at the American College of Obstetricians and Gynecologists.

Despite the study’s contributions, researchers acknowledge its limitations. The retrospective design may have restricted the ability to control for variables such as operator expertise or patient comorbidities. Additionally, the study’s sample was predominantly sourced from tertiary care centers, which may not reflect outcomes in primary care settings.

The study’s authors recommend further research to explore the long-term outcomes of patients managed based on HSG results versus laparoscopy. They also call for standardized protocols to improve the consistency of HSG interpretations across institutions.

For subfertile women, the findings offer a nuanced