Background: Tubal factor infertility accounts for approximately 25–35% of infertility cases, necessitating accurate diagnostic methods. Conventional HSG, though widely used, is associated with discomfort and radiation exposure. SIS-HSG provides a safer, radiation-free alternative with real-time imaging. Objective: This study aimed to assess the efficacy, safety, and diagnostic accuracy of SIS-HSG compared to conventional HSG in evaluating tubal patency among infertile women in Bangladesh. Methods: A prospective comparative study was conducted at Islami Bank Medical College, Rajshahi, and Popular Diagnostic Center, Rajshahi, Bangladesh, from January 2023 to December 2024. A total of 132 women with suspected tubal factor infertility underwent both SIS-HSG and conventional HSG. Tubal patency, procedural discomfort, complications, and diagnostic concordance were analyzed using statistical methods, including standard deviation (SD) and p-values. Results: SIS-HSG demonstrated a tubal patency detection rate of 92.4%, comparable to conventional HSG at 94.7% (p = 0.34). The sensitivity and specificity of SIS-HSG were 91.2% and 95.5%, respectively, with a diagnostic accuracy of 93.3%. The mean procedural pain score for SIS-HSG was significantly lower (3.1 ± 1.2) compared to HSG (5.7 ± 1.5) (p < 0.001). The rate of adverse reactions was reduced in SIS-HSG (3.8%) compared to HSG (12.1%) (p = 0.015). Standard deviation for procedural duration in SIS-HSG was 2.4 minutes, significantly shorter than HSG (SD = 4.1 minutes) (p = 0.002). Conclusion: SIS-HSG offers a reliable, less painful, and radiation-free alternative for tubal patency assessment. Its high diagnostic accuracy and improved patient tolerance advocate for its integration into routine infertility diagnostics.