The use of radiography in reproductive medicine

Advances in three-dimensional ultrasonography, magnetic resonance imaging, and significant improvements in endoscopic and microendscopic visualization procedures challenged the role of radiography of the uterus and fallopian tubes using contrast materials. The ultimate role of hysterosalpingogram (HSG) in clinical evaluation of the infertile couple remains a complex decision that is influenced by diagnostic accuracy, access to equipment, the cost of the procedure, and concomitant improvements in competing procedures, such as laparoscopy and falloposcopy. Advancements in in vitro fertilization with ever-increasing pregnancy rates resulted in yet another threat to the traditional HSG. If pregnancy rates increase at the present rate, and natural reproduction becomes less efficient than assisted reproductive procedures, then clinical evaluations of the fallopian tubes may become obsolete. Under these hypothetical circumstances, infertile patients will be referred directly to IVF without evaluation of their fallopian tubes. This radical scenario is unlikely to occur in the near future, because of the complexity and increasing costs and limited access to this technology in many countries and to many patients.