To assess the accuracy of the diagnosis of tubal occlusion with the use of color Doppler flow ultrasonography and hysterosalpingography, 129 infertile women were studied. All 129 women had the procedure performed with an ATL Ultramark 9 (Advanced Technology Laboratories, Bothel, Wash.) color Doppler ultrasonography machine. Eighty-five of the 129 women also had an additional study including x-ray hysterosalpingography and/or chromopertubation. Of these 85 women, 58 had pelviscopic examination with chromopertubation. The frequency of diagnosis of tubal occlusion was compared among the three methods. When results of ultrasonography-hysterosalpingography were compared with those of x-ray hysterosalpingography and/or chromopertubation, 69 of 85 (81%) studies showed agreement, and 50 of 58 (86%) ultrasonography-hysterosalpingography findings agreed with observations at chromopertubation. The frequency of comparable findings between x-ray hysterosalpingography and chromopertubation is 75%. These data suggest that ultrasonography-hysterosalpingography is at least as accurate as x-ray hysterosalpingography in diagnosing tubal occlusion. In addition, ultrasonography-hysterosalpingography is safer and more cost-effective than x-ray hysterosalpingography and chromopertubation.