Place of Hysterosalpingography (HSG) to examine female genital tract and its clinical correlation in infertility

INTRODUCTION: Infertility is a worldwide problem so that examination of an infertile couple becomes more important nowadays. Investigation of female genital tract is the keystone of female infertility. Hysterosalpingography has been using for examine Uterus and tubes for one hundred years and whether protecting its validity is our main subject. METHODS: Patients who admitted Sakarya University Education and Research Hospital infertility policlinic and went on her treatment with her husband between 2015-2019 years included the study. We had 517 patients who met the criteria. Patients who were investigated by HSG with water-based kontrast in scopi room without sedation but they had one oral painkiller an hour before the procedure. We used electronic archive for collecting HSGs but gave X ray films on patients' hands. We collected datas such as age, gravida, parity, BMI(body mass index), other blood test sor radiological tests, whether there was male factor or ongoing pregnancy from electronic archieves or documents from archieve rooms. When we could not find enough information, we found registered phone numbers and called patients. RESULTS: Mean age of patients is 30,61; BMİ is 25,57; primary infertility rate is 69,6%; secondary infertility rate is 30,4%; uterin anomaly is 27,5%; mullerian anomaly is 12,7%, tubal anomaly is 17,2%, istmocel is 6%, male factor is 27,9%, unexplained infertility 19,1%, poor ovarian reserve is 33,3% (cut off is 1,5) PCOS is 23%23 found. There is a significant relations between PCOS and mullerian and tubal anoamly. There is a significant relations between hydrosalphinx and tubal anomaly, endometriosis, peritubal adhesions. When we take filling defects and uterin anomaly, sensitivity of HSG is 87,87% and spesifity of HSG is 81,43% found. CONCLUSION: HSG is a valuable test for diagnosing female infertility. Not only increased pregnancy rate but also investigation of new factors of infertility such as istmocele make the test still important. We may also say we are able to examine both Uterus and tubes in one test. It is not as invasive as laparoscopy which is gold standart for tubal patency or it is not as expensive as MR which examine uterin anomalies. Three dimensions USG (3 D USG) is not avaible every infertiklity center. CAT(chlamydia antibody test) is not affordable to examine tubal pathologies except chlamidya such as tuberculosis or endometriosis. We do not know whether Sono-HSG is as successfull as HSG for increasing pregnancy rates after the procedure. To sum up, when we consider all technics to examine infertile women's uterus and tubes HSG is still useful and costeffective diagnostic test as long as it contains individual and clinic's characteristic opportunities. Key Words: Infertility, Hysterosalpingography(HSG), Istmocele, Mullerian anomaly and PCOS