Male factor infertility may be associated with a low risk for tubal abnormalities

Abstract

This study assessed the association of an abnormal hysterosalpingography (HSG) with clinical characteristics and infertility investigation results in 1359 women who underwent HSG as part of their infertility work-up. A normal HSG result was found in 1031 tests (75.9% of all HSG tests). Significantly positive predictors of tubal occlusion on multivariate analysis were longer duration of infertility (OR 1.072, 95% CI 1.006–1.143), previous pelvic inflammatory disease (PID; OR 2.172, 95% CI 1.176–4.008), extrauterine pregnancy (EUP; OR 15.74, 95% CI 6.66–37.16) and any abdominal surgery (except Caesarean section; OR 1.503, 95% CI 1.120–2.017) and negative predictor was male factor infertility (OR 0.543, 95% CI 0.401–0.735). The presence of male factor decreased the risk of tubal abnormality from 32.4% to 15.6% ( P < 0.001) in women with known risk factors for tubal abnormalities (previous PID, EUP or abdominal surgery) and from 17.8% to 11.5% ( P = 0.01) in women at low risk for tubal abnormalities. As the risk for tubal factor is approximately 1:10 in patients with male factor infertility without other risk factors, the practice of postponing HSG until after one or two treatment cycles may be considered. Uterine cavity and Fallopian tube patency are routinely investigated during an infertility work-up. The first-line tool is hysterosalpingography (HSG), because of its high specificity for ruling out tubal obstruction and cost-effectiveness. The main drawbacks of the HSG test are pain and risk of infection. The HSG findings are incorporated into the algorithm of the infertility investigation to identify the cause of infertility. Our study assessed the risk for abnormal HSG in relation to patient clinical characteristics and infertility investigation results in 1359 women who underwent HSG as part of their infertility work-up. A normal HSG result was found in 1031 tests (75.9% of all HSG tests). Significant predictors of tubal occlusion on multivariate analysis were longer duration of infertility, previous pelvic inflammatory disease (PID), extrauterine pregnancy (EUP), any abdominal surgery (except Caesarean section) and a negative predictor was male factor infertility (OR 0.543, 95% CI 0.401–0.735). The presence of male factor decreased the risk of tubal abnormality from 32.4% to 15.6% ( P < 0.001) in women with known risk factors for tubal abnormalities (previous PID, EUP or abdominal surgery) and from 17.8% to 11.5% ( P = 0.01) in women at low risk for tubal abnormalities. Our findings suggest a negative association between male factor and tubal factor infertilities. As the risk for tubal factor is approximately 1:10 in patients with male factor infertility without other risk factors, the practice of postponing HSG until after one or two treatment cycles may be considered.