Common technical errors in hysterosalpingography

Hysterosalpingograms from 100 consecutive patients referred for in vitro fertilization were reviewed to evaluate the adequacy of visualization of the uterine cavity. In 17 cases the hysterosalpingogram failed to demonstrate the entire uterine cavity. The most common reason for failure was an axial view of the uterus secondary to inadequate traction on the cervix in 82% (14/17) of the cases, followed by obstructed visualization of the lower uterine cavity and endocervical canal by the delivery catheter bulb in 21% (3/17). A speculum left in the vagina obscured visualization of the endocervical canal in 21% (3/17) of the cases. There were no significant differences in the mean number of radiographic exposures between the adequate and inadequate groups (4.7 vs. 5.9). This study suggests that failing (1) to remove the speculum before injecting contrast, (2) to evaluate the lower uterus and endocervix when using an intrauterine catheter, or (3) to place adequate traction on the cervix, may result in inadequate visualization of the uterine cavity and a need to repeat the study.