Background: Infertility is a complex global health issue, affecting millions of couples and necessitating detailed diagnostic evaluations. Among the various diagnostic procedures, X-ray hysterosalpingography (HSG) is pivotal for assessing tubal patency and identifying underlying causes of infertility. Objective: To determine the frequency of tubal blockages, particularly hydrosalpinx, in patients undergoing HSG at a tertiary care facility. Methods: This retrospective study was conducted at Allama Iqbal Teaching Hospital DG Khan from July 2022 to February 2024. A total of 210 female patients with consecutive infertility were included, excluding those with prior tubal surgeries. Data were extracted from medical records, focusing on demographics, clinical history, and HSG results. Results: The mean age of the participants was 32.35 ± 3.56 years, and the mean duration of infertility was 3.5 ± 2.1 years. Among the patients, 65% were nulliparous, and 35% were parous. Prior fertility treatments were reported in 75% of cases. Tubal blockage was identified in 45 patients (21.4%), with 25 (11.9%) exhibiting unilateral blockage and 20 (9.5%) bilateral blockage. Hydrosalpinx was the most common abnormality, occurring in 30 patients (66.7%). Conclusion: Tubal blockage, particularly hydrosalpinx, is a significant contributor to infertility, found in 21.4% of the study population. These findings emphasize the need for thorough tubal evaluations in infertility assessments.