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

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.