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Background: Hysterosalpingography (HSG) is widely used as a first-line test of tubal patency, but local data on its tubal and uterine findings in Owerri are limited. Objective: To assess tubal patency among women undergoing infertility evaluation with HSG in two diagnostic centres in Owerri by determining the tubal patency status, describing tubal and uterine cavity findings, determining the pattern (and, where recorded, the site) of tubal blockage and the type of infertility, and comparing the findings between the centres. Methods: This retrospective cross-sectional study reviewed 200 conventional X-ray HSG records (100 from each of two private diagnostic centres) from 1 February to 27 July 2026. Age, type of infertility, uterine findings, left and right tubal status, site of blockage, peritoneal spill and associated findings were extracted. Data were summarized as frequencies, percentages and 95% Wilson confidence intervals; the chi-square test compared the centres (significance, p < 0.05). Results: The mean age was 33.75 ± 6.88 years, and 86.0% of women were aged 25-44 years. Bilateral patency was found in 127 women (63.5%), unilateral blockage in 44 (22.0%) and bilateral blockage in 29 (14.5%). The left tube was blocked in 60 (30.0%) and the right in 42 (21.0%). Free peritoneal spill was present in 168 (84.0%). Hydrosalpinx (15.5%), leiomyoma (12.5%) and endometrial polyp or suspected polyp (7.0%) were the commonest associated findings, and 33 uterine cavities (16.5%) were abnormal. Secondary infertility (55.0%) was commoner than primary (44.5%). Bilateral patency was recorded in 69.0% and 58.0% at the two centres, but the difference was not significant (χ² = 2.718, df = 2, p = 0.257). In exploratory analyses, any tubal blockage was more frequent in women aged 35 years and above (44.7% versus 30.4%, p = 0.038). Conclusion: About one in three women evaluated for infertility had at least one blocked tube on HSG, and the examination also showed uterine and peritubal abnormalities. This study describes HSG findings and does not measure the effectiveness of HSG: the findings were not confirmed by a reference test, the site of blockage was not recorded for 43.8% of women with a blocked tube, and only the type of infertility, not other clinical indications, was recorded. Findings should therefore be interpreted with caution. Standardized reporting and complete documentation are recommended.