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Abstract Background: Hysterosalpingography (HSG) remains a widely available first-line imaging investigation for tubal patency and uterine cavity assessment in infertility work-up, particularly in settings where laparoscopy, hysteroscopy and contrast sonography are not universally available. Objective: To determine the pattern of HSG findings, age distribution and clinical indications among women undergoing HSG in Enugu metropolis, South-East Nigeria. Methods: This retrospective descriptive study reviewed 216 complete HSG reports from the Radiology Department of Good Shepherd Specialist Hospital, Uwani, Enugu, covering January 2024 to June 2026. Data on age, clinical indication and HSG findings were extracted into a structured sheet and summarized using frequencies, percentages, mean, standard deviation and 95% Wilson confidence intervals for key proportions. Results: The mean age was 35.8 +/- 5.7 years (range, 22-48 years), and the largest age group was 35-39 years (32.9%). Abnormal HSG findings were recorded in 169/216 women (78.2%; 95% CI, 72.3-83.2), while 47/216 (21.8%; 95% CI, 16.8-27.7) had normal studies. The commonest findings were uterine leiomyoma (26.4%; 95% CI, 21.0-32.6), peritubal adhesions (20.8%; 95% CI, 16.0-26.7) and tubal occlusion/blockage (13.0%; 95% CI, 9.1-18.1). Secondary infertility was the main indication for HSG (54.6%; 95% CI, 48.0-61.1), followed by primary infertility (35.2%; 95% CI, 29.1-41.8). Conclusion: Structural uterine and tubal abnormalities were common among women referred for HSG in this facility, with secondary infertility predominating. Earlier fertility evaluation, improved prevention and treatment of pelvic infections, and integrated management pathways for fibroids and tubal disease may reduce the burden of infertility in this setting.