A 30-year-old presents with primary infertility of 3 years. Hysterosalpingography shows bilateral tubal occlusion at the cornual end. Semen analysis is normal. Her next best investigation to assess cornual tubal status before surgery is:

• A Repeat hysterosalpingography after hormonal priming
• B Laparoscopy with chromopertubation only
• C Selective salpingography with tubal catheterisation ✓
• D MRI pelvis with dynamic contrast

Explanation

Cornual (proximal) tubal occlusion on HSG is a false-positive in up to 20-40% of cases due to cornual spasm rather than true obstruction. Selective salpingography — catheterising the uterine ostium under fluoroscopic guidance and injecting contrast directly into the tube — can unblock a spasm-related obstruction and confirm or exclude true cornual occlusion. Tubal catheterisation can also be therapeutic for mild cornual adhesions. Laparoscopy with chromopertubation assesses patency from the fimbrial end and cannot diagnose cornual block specifically. MRI has limited role in tubal patency assessment.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.