What is the first-line imaging test to assess tubal patency in infertility evaluation?

• A. Laparoscopy is the first-line evaluation.
• B. Transvaginal ultrasound alone is sufficient for tubal patency.
• C. Hysterosalpingography (HSG) is the first-line imaging to assess tubal patency.
• D. MRI is the standard initial test.

Answer: (C)

Hysterosalpingography is the first-line imaging test for evaluating tubal patency because it directly visualizes both the uterine cavity and the fallopian tubes by injecting a radiopaque contrast and taking X-ray images as it flows through. If the contrast passes freely into the peritoneal cavity, the tubes are patent; if not, there may be blockage or occlusion. This test also reveals intracavitary or intrauterine abnormalities that could affect fertility, such as polyps or fibroids. It’s less invasive and more accessible than surgical options, and it provides functional information about patency in a single study. Laparoscopy with dye is more definitive and can assess peritoneal factors, but it’s invasive and reserved for further evaluation or treatment. Transvaginal ultrasound alone can’t reliably determine tubal patency, and MRI isn’t used as the standard initial test due to cost and limited functional assessment.