Tubal Pathology on Hysterosalpingography in Women with Unoperated Endometriomas: a Comparative Analysis

This matched comparative study investigates whether unoperated ovarian endometriomas (OMAs) influence the prevalence of tubal pathology as detected by hysterosalpingography (HSG) in infertile women. A total of 266 infertile women with unilateral or bilateral OMAs ≥ 2 cm and 539 matched controls without endometriomas were included between January 2021 and October 2024. Diagnosis of OMAs was confirmed by transvaginal ultrasonography and, if necessary, MRI, and all participants underwent standardized HSG assessment. Tubal pathologies were classified into nine distinct categories. The OMA group showed significantly higher rates of tubal abnormalities (31.6% vs. 10.8%, p < 0.001), with unilateral hydrosalpinx and phimosis being notably more common. Logistic regression identified age and OMA presence as independent predictors, and ROC analysis suggested a cutoff of 4.5 cm for increased risk. These findings indicate that unoperated OMAs, especially when ≥ 4.5 cm, are associated with a markedly increased risk of tubal pathology. Early tubal assessment may be beneficial for individualized fertility planning in this population.