Diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility in a referral clinical setting: a Port Harcourt, Nigeria experience

Abstract

Introduction intrauterine pathologies were traditionally evaluated by blind dilatation and curettage along with hysterosalpingography. Hysteroscopy is a veritable tool for evaluation of uterine cavity pathologies with an increasing availability in Nigeria. The study aims to report the diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility from a Nigerian metropolis. Methods a retrospective cross-sectional study of consecutive cases of infertile women referred for hysteroscopy to an ambulatory care endoscopy facility in Port Harcourt, Nigeria. The variables collated included age, parity, past gynaecological history, indication, hysteroscopy findings and interventions. Statistical analysis was performed using SPSS version 25. Results included in study were 75 patients undergoing a total of 124 hysteroscopic procedures. The age range of patients was 25 to 56 years (mean 40.7 ± 5.9 years). A positive diagnostic yield of 93.3% with non-visualization of intracavitary uterine pathology in 5 patients was recorded. The most common pathologies were submucous myoma-25(31.3%), endometrial polyps- 18(22.5%) and intrauterine adhesions-18(22.5%). There was no statistical difference between the mean age of patients with or without polyp, myoma and intrauterine adhesions (P = 0.185, P = 0.510 and P = 0.619 respectively) but a non-linear relationship between age and polyp detection (Eta2 = 0.024). Operative hysteroscopies were all performed on out- patient basis but staged in 30(40.0%) patients. Conclusion benign uterine growths and intrauterine adhesions are frequent causes of uterine factor infertility. A high successful completion rate of hysteroscopic interventions was achieved.

Hysteroscopic findings and intrauterine pathology treatment in Mexican infertile women

“…9,15,17 In our analysis, primary infertility had a frequency of 79.1% and secondary infertility 20.9%, similar to data by several authors, where primary infertility was also more prevalent than secondary: Koskas (73.4% vs. 26.6%), El Huseiny (63.4% vs 36.5%), Farag (88% vs 12%), Citu (67.7% vs 32.3%), Ali (70% vs. 30%); unlike from the Pansky data, whose frequency of both types of infertility was similar (48% vs. 52%) and also different to that reported by Emeka, in whose study population in Nigerian women, secondary infertility was more frequent (20% vs. 80%). 7,11,12,14,15,17,18 We found a global frequency of intracavitary pathology of 61.8%, similar to that described by Citu (63.1%), Farag (69.7%), Eskalen (76.8%) and Viveros (74%); the latter, also carried out in Mexican population. On the contrary, previously published data showed a lower overall frequency of alterations in the uterine cavity: Santi (17%), El Huseiny (20.4%), Ali (29%), Pansky (30%) and Koskas (40%).…”

“…On researches by El Huseiny, Pansky and Koskas, the prevalence of endometrial polyps was substantially lower (5.3%, 7.6% and 9.7%, respectively). 7,11,13,14,18,[20][21][22][23][24] The second most frequent pathology, with 15.7% was chronic endometritis, data similar to that described by Koskas (16%) in his description of hysteroscopic findings in French women, but different from that reported by other authors such as Citu, Farag and Emeka (0.5%, 0.8% and 1.2%, respectively). Although the gold standard for diagnosis of chronic endometritis is histological detection of plasma cells at the endometrial stroma, literature describes the high sensitivity and specificity (86.36% and 87.30%, respectively) of hysteroscopic diagnosis in the histological confirmation of chronic endometritis, with a diagnostic accuracy by this means of 93.4%, using criteria proposed by Cicinelli's group in 2005: focal or diffuse endometrial hyperaemia: marked accumulation of blood vessels at periglandular level, with a white central point "strawberry appearance", stromal edema (pale and thickened endometrium in the proliferative phase) and micropolyps (<1 mm).…”

“…Although the gold standard for diagnosis of chronic endometritis is histological detection of plasma cells at the endometrial stroma, literature describes the high sensitivity and specificity (86.36% and 87.30%, respectively) of hysteroscopic diagnosis in the histological confirmation of chronic endometritis, with a diagnostic accuracy by this means of 93.4%, using criteria proposed by Cicinelli's group in 2005: focal or diffuse endometrial hyperaemia: marked accumulation of blood vessels at periglandular level, with a white central point "strawberry appearance", stromal edema (pale and thickened endometrium in the proliferative phase) and micropolyps (<1 mm). 7,12,14,15,[25][26][27][28][29] In order of frequency, fibroids were the third most prevalent intracavitary pathology in our population, with 7.6%; similar to data reported by Ali, Koskas and Farag (8%, 5.4% and 5.2%), but different from numbers reported by Viveros in Mexico (19%) and Emeka, in his study of Nigerian women (31%), figures consistent with the global epidemiology of myomatosis, which mentions a fibroids prevalence three times higher in black women than in other populations. 7,13,14,15,17,30 Uterine synechiae were the fourth most prevalent pathology in our study, with a frequency of 6.5%, figures similar to those described by El Huseiny (6.4%), Farag women, the main risk factor for adhesions was present.…”

“…In Mexico, it is reported that 17% of women of reproductive age suffer from infertility. 7,8 Intrauterine pathology negatively affects fertility by decreasing endometrial receptivity and embryo implantation success. If ultrasound, sonohysterography and hysteroscopy are compared for the evaluation of structural intrauterine abnormalities, the sensitivity and specificity of each study are: 89% / 56%; 91.8% / 60% and 97.3%/92%, respectively.…”

Anatomical Causes of Infertility Diagnosed Using Imaging Tests in A Group of 100 Women

“…Perhaps the most intersting finding in this laparoscopy which was indicated for patients with no PID based on the crtieria of good spontanous or induced ovulation continuing for at least two cycles, laparscopy still showed clear evidence of PID in 8 patients, raising the number of PID patietns in the study group to 48, the additional cases were among the 16 cases were unsuspected either because they were asymptomatic, which is likely since a large proportion of PID patients may be asymptomatic [20]. Also, TVS didn't detect PID.…”