The objective of this study is to evaluate the diagnostic and practical value of hysterosalpingography (HSG) in diagnosing tubal infertility by comparing it with laparoscopy. We analyzed 273 fallopian tubes from 143 infertility patients who underwent laparoscopic surgery at the Department of Reproductive Medicine, Affiliated Hospital of Hebei University, between December 2019 and December 2022. These patients were indicated for HSG due to suspected fallopian tube obstruction prior to and following surgery. The findings revealed that the sensitivity of HSG in diagnosing tubal patency was 55.66% (59/106), specificity was 98.80% (165/167), and coincidence rate was 82.05% (224/273). For proximal tubal obstruction diagnosis, sensitivity was recorded at 79.37% (50/63), specificity at 76.67% (161/210), and coincidence rate at 77.29% (211/273). Additionally, sensitivity for pelvic adhesiveness diagnosis stood at a mere 34.38% (33/96), with specificity being significantly higher at 85.11% (40/47) and a coincidence rate of only 51.05% (73/143). Consequently, we conclude that while HSG serves as an initial screening method for assessing fallopian tube patency, it exhibits a notable rate of missed diagnoses concerning fallopian tube pathologies and offers limited utility in identifying pelvic adhesions; conversely, laparoscopy can provide therapeutic insights into both fallopian tube lesions and pelvic conditions.