Evaluation of pregnancy outcomes using a novel hysterosalpingography scoring system for tubal patency

This study aims to evaluate pregnancy rates using a novel classification system based on hysterosalpingography (HSG) findings, categorizing tubal patency as either patent or functionally deficient. Furthermore, the study assesses the predictive value of this scoring system for fertility outcomes.

A retrospective cohort study was conducted involving 4461 patients who underwent HSG at an academic radiology center between January 2020 and December 2022. HSG findings and subsequent pregnancy outcomes were systematically analyzed.

Of the 2461 patients initially followed up, 301 were excluded due to incomplete data, resulting in a final cohort of 2160 patients. Within two years post-HSG, 970 patients (44.9 %) achieved natural pregnancy, 808 (83.2 %) of whom resulted in live births. In vitro fertilization (IVF) pregnancies accounted for 35.8 % (n = 775). Ectopic pregnancies occurred in 1.8 % of patients, with a higher incidence in those with unilateral tubal occlusion. Using the novel scoring system-where Score 0 indicates bilateral patency, Score 1 indicates unilateral functional deficiency, and Score 2 indicates bilateral functional deficiency-the Score 0 group exhibited the highest natural pregnancy rate (51.1 %), which was significantly higher than that of the Score 1 and Score 2 groups. Natural pregnancy rates were 20.8 % for unilateral hydrosalpinx and 36.7 % for unilateral occlusion. Only 5 % of patients with bilateral hydrosalpinx conceived naturally. Age was a significant factor; women under 35 years had a natural pregnancy rate of 46.8 %, compared to 10.2 % in those over 40 years.

Tubal patency status is significantly associated with pregnancy outcomes, and functional deficiencies appear to reduce fertility. The proposed HSG-based scoring system serves as a valuable predictive tool for pregnancy potential. Additionally, the presence of hydrosalpinx is associated with adverse pregnancy rates.