Evaluation of hysterosalpingographic findings among patients presenting with infertility

Abstract

Background Infertility is a global health issue and hysterosalpingography (HSG) is a valuable radiological tool in infertility workup and remains a main modality for investigating female infertility. However, the HSG findings of infertility are not the same worldwide. This study aimed at evaluating the incidence of HSG findings in patients investigated for primary and secondary infertility, correlating these findings with their clinical data that reflect the infertility causes and comparing the findings with previous international studies. Methods A prospective descriptive study of 75 female patients referred, as cases of infertility, for HSG examination in Elrebat Hospital and Khartoum Advanced Diagnostic Center. HSG was performed in the first half of the cycle. The procedure and its complications, were explained to the patients and informed consents were obtained. Patients with active pelvic infection and active uterine or vaginal bleeding were excluded from the study. Using aseptic technique and with proper patient’s positioning, iodinated contrast was introduced into the cervix under fluoroscopic monitoring, to demonstrate the uterine cavity, fallopian tubes and free spillage into the peritoneal cavity. Personal data, clinical data and HSG findings were analyzed using SPSS version 23. Results The commonest age group seen was 26–36 years. Close incidences of primary and secondary infertility were detected. 52.7% had abnormal findings in HSG. Tubal pathology (42.7%) being the most common abnormality, followed by uterine and combined abnormalities. There was strong association between past medical history suggesting pelvic inflammatory disease (PID) or past history suggesting tubal blockage secondary to abdominopelvic surgery and tubal abnormalities. Conclusion HSG examinations revealed that the most common abnormality was tubal blockage possibly complicating PID and abdominopelvic surgeries. This reflects the HSG diagnostic and therapeutic role in the assessment of female infertility and the further needs for more preventive measures targeting the reduction of tubal pathologies in developing countries.

Hysterosalpigography findings of female partners of infertile couple attending fertility clinic at Lagos University Teaching Hospital

“…Although some studies have reported primary infertility as the predominant type among women who had HSG for evaluation of infertility [ 7 , 19 ], secondary infertility was the most predominant type of infertility in this study. Similar studies in in Nigeria [ 4 , 14 , 15 ] and other parts of the world [ 19 ] have reported secondary infertility as the commonest type among female partners of couples with infertility undergoing HSG. This finding may be attributed to the prevalent cause of female infertility in the study population such as pelvic infection or pelvic inflammatory disease.…”

Intrauterine adhesions, peritubal adhesions and tubal occlusion on hysterosalpingography

“…The age ranges in women undergoing HSG on account of secondary infertility is scarce in the available literature. However, our finding was in agreement with 30-39 years recorded in a study of women with infertility done in Ile-Ife 7 in a society of predominantly different ethnic and cultural group from ours, but of the similar racial and religious disposition; but differed from 26-36 years age group recorded by Toufig et al 32 in a different country with different cultural, religious and educational background. This suggests a cultural, religious and educational influence.…”

“…Among women with infertility, strong association was found between tubal blockage and past medical history suggestive of previous PID by Toufig et al 32 and this is in concordance with that obtained in Ile-Ife. 7 But, the report of a strong association between tubal abnormalities and history of previous abdominopelvic surgery by Toufig et al 32 is at variance with the report by a study in Benin 27 that found no correlations between tubal blockage and history of previous pelvic surgery. The finding of significant association between tubal blockage and positive history of previous D&C by a study in Ile-Ife 7 also differs from the report of no significant correlation between the two variables by another in Benin.…”

“…The finding of no significant correlation between PID and tubal occlusion or peritubal adhesions in our study differed from the report of both Famurewa et al 7 and Toufig et al 32 The finding of no significant correlation between D&C and tubal occlusion in our study agreed with that obtained in Benin 27 but was in discordant with that obtained in Ile-Ife. 7 Similarly, the absence of significant correlation between history of abdominopelvic surgery and tubal occlusion in our study was in concordance with that of Eze et al 27 but disagreed with that of Toufig et al 32 Though the reasons for these variations are not obvious, the observations agree with the assertion by Toufig et al 32 that there are variations in the HSG findings in infertility globally. However, general improvement in the available medical expertise and the level of education over time may most likely play a role in explaining the changes.…”

Hysterosalpingography Findings among Women Presenting for Infertility Evaluation

“…It is easily accessible and is typically the initial step in the imaging evaluation of the fallopian tubes in cases of infertility, particularly in underdeveloped nations like our own. 10 The results of this study indicate that the average age is 32.50 years, and it also demonstrated that the majority of infertile women who presented themselves for HSG were between the ages of 30 and 34 years old. This should not come as a surprise given that we have reached the pinnacle of the female reproduction stage.…”