Infertility is a major clinico-social problem affecting many couples and hysterosalpingography (HSG) is still a very valuable and commonly used procedure in the work-up of women with infertility.  However, the approach should be in a step-wise manner; starting with simple non-invasive investigatons .  

Radiological reports of hysterosalpingograms done on women with suspected infertility at Royal Care Hospital-Khartoum- Sudan, during the period (June 2016-June 2017) were retrospectively reviewed. Clinical notes and radiological findings were analyzed.

The most common age group noted was (27 – 35) years. Primary infertility was more common than secondary infertility. Most of hysterosalpingograms were normal (64%) while abnormal findings were found in only 36%. The most common abnormal finding was tubal blockage.

Hysterosalpingography remains an indispensable tool for evaluation of infertile woman. However, being an invasive procedure that exposes the patient to radiation, it should not be rushed into before excluding hormonal and male factors. Having most of hysterosalpingograms being normal merits looking into and digging more whether those women have really had infertility or other factors rather than tubal factor is the cause of infertility.  Primary infertility (69%) was much more common than secondary type which may support the forementioned point. Tubal blockage was the most prevalent abnormal HSG finding, more commonly bilateral and there was a statistically significant correlation between the age of the patient and type of infertility.

• Couples should be counselled and educated about infertility.
• Proper gynecologic examination of the patients by their clinicians helps avoid unexpected cancellation of the procedure for reasons that may be detected during examination.
• Simple non-invasive investigations of infertility should be carried out before sending the patient for HSG as many patients would  undergo HSG simply because the male factor has been neglected!!!
• Proper documentation of the patient’s relevant history in the report helps to maximize the benefit of future researches.

It's a pleasure to have the opportunity to say 'Thank You' for all the loving support and help I got from my fabulous family, friends and colleagues until this work has seen the light . My only regret is that while I'd like to write all the names simultaneously, the appropriate technology doesn't seem to have been invented yet.

I would like to express my sincere gratitude and thankfulness to my supervisor and great mentor; Dr. Sahar A.T Ayoub, for her guidance and meticulous supervision throughout this work. Her valuable advice and comments are highly appreciated.

1.      Abubakar A, Ali YM, Nwobi IC, Nkubli BF, Miftaudeen MN, Njiti MM, Luntsi G, Moi AS, Kurama MB, Gunda NM. Common Hysterosalpingography Protocols and Findings among Infertile Women in a Tertiary Healthcare Institution in Northeast, Nigeria.

2.      Abubakar M, Njiti M, Mathew E, Abubakar A, Joseph D, Moi S, Nkubli F, Lunsti G. Evaluation of hysterosalpingographic (HSG) findings among suspected infertile women at Abubbakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi. Int Res Med Sci. 2016;3:55-9.

3.      Bello TO. Pattern of tubal pathology in infertile women on hysterosalpingography in Ilorin, Nigeria.

4.      Belsey MA. The epidemiology of infertility: a review with particular reference to sub-Saharan Africa. Bulletin of the World Health Organization. 1976;54(3):319.

5.      Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Iron intake and risk of ovulatory infertility. Obstetrics & Gynecology. 2006 Nov 1;108(5):1145-52.

6.      Eng CW, Tang PH, Ong CL. Hysterosalpingography: current applications. Singapore medical journal. 2007 Apr;48(4):368-73.

7.      Goodman SB, Rein MS, Hill JA. Hysterosalpingography contrast media and chromotubation dye inhibit peritoneal lymphocyte and macrophage function in vitro: a potential mechanism for fertility enhancement. Fertility and sterility. 1993 May 1;59(5):1022-7.

8.      Ibekwe PC, Udensi MA, Imo AO. Hysterosalpingographic findings in patients with infertility in South eastern Nigeria. Nigerian Journal of Medicine. 2010;19(2).

9.      Johnson NP, Kwok R, Stewart AW, Saththianathan M, Hadden WE, Chamley LW. Lipiodol fertility enhancement: two-year follow-up of a randomized trial suggests a transient benefit in endometriosis, but a sustained benefit in unexplained infertility. Human reproduction. 2007 Sep 21;22(11):2857-62.

10.  Kiguli-Malwadde E, Byanyima RK. Structural findings at hysterosalpingography in patients with infertility at two private clinics in Kampala, Uganda. African health sciences. 2004;4(3):178-81.

11.  Mgbor SO. Pattern of hysterosalphingographic findings in gynaecological patients in Enugu. Nig Med J. 2006;47:14-6.

12.  Pollard I. A guide to reproduction: social issues and human concerns. Cambridge University Press; 1994 Jun 23.

13.  Ryan S, McNicholas M, Eustace SJ. Anatomy for Diagnostic Imaging E-Book. Elsevier Health Sciences; 2011 Dec 2.

14.  Santhalia PK, Gupta MK, Uprety D, Ahmad K, Ansari S, Agrawal N, Rauniyar RK. Role of Radiographic Hysterosalpingography in Infertility in Eastern Nepal. Nepalese Journal of Radiology. 2013 Oct 6;3(1):59-66.

15.  Schwabe MG, Shapiro SS, Haning RV. Hysterosalpingography with oil contrast medium enhances fertility in patients with infertility of unknown etiology. Fertility and sterility. 1983 Nov 1;40(5):604-6.

16.  Sharma S, Mittal S, Aggarwal P. Management of infertility in low resource countries. BJOG: An International Journal of Obstetrics & Gynaecology. 2009 Oct 1;116(s1):77-83.

17.  Úbeda B, Paraira M, Alert E, Abuin RA. Hysterosalpingography: spectrum of normal variants and nonpathologic findings. American Journal of Roentgenology. 2001 Jul;177(1):131-5.

18.  Weissleder R, Wittenberg J, Harisinghani MG, Chen JW. Primer of diagnostic imaging.