Association between secondary infertility and fallopian tube obstruction on hysterosalpingography

To determine whether women with secondary infertility have a lower prevalence of tubal pathology as evidenced by hysterosalpingographic (HSG) analysis.

A cross-sectional study was performed on 551 women seen for evaluation of infertility at an academic medical center. Each patient's chart was reviewed for the presence of primary vs. secondary infertility. History of sexually transmitted infection, prior surgery and details of prior pregnancies were recorded. HSG reports and films were evaluated for evidence of tubal disease.

Controlling for 5-year age category, history of sexually transmitted disease and history of surgery, the adjusted risk ratio for abnormal HSG in women with secondary vs. primary infertility was 1.75 (95% CI 1.16-2.64). Among patients with secondary infertility, there was no difference between mode of delivery in the prior pregnancy (vaginal vs. cesarean delivery) and abnormal HSG.

In the population we studied, accounting for confounding variables, women with secondary infertility had a higher likelihood of having fallopian tube obstruction on hysterosalpingography than did those with primary infertility. Our study supports continued routine evaluation for tubal patency in patients with secondary infertility. Among parous women, there is no evidence that cesarean delivery places patients at increased risk of abnormal hysterosalpingograms.