Hysterosalpingographic (HSG) pattern of infertility in women of reproductive age

Abstract

Background:Infertility is a complex disorder with significant medical, psychological and economic problems.Aims:The aim of the study is to evaluate the structural abnormalities of the uterus and fallopian tubes in infertile women as elucidated by hysterosalpingography.Setting and Design:A retrospective study, conducted at the Radiology and Obstetric and Gynaecologic Departments of a tertiary health care institution.Materials and Methods:Evaluation of all consecutive patients in whom hysterosalpingographic (HSG) was performed for infertility between July 2013 and June 2015 in the Department of Radiology. For the biodata, indications for the investigation and the HSG findings were obtained.Statistical Analysis:The data were analyzed using IBM Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) for Windows, version 20 software.Results:A total of 299 patients were evaluated. Of these, 250 were for infertility with primary and secondary infertility constituting 18.4 and 81.6%, respectively. Seventy percent of the cases for infertility had abnormalities on the HSG. Normal uterine cavity was found in 123 (49.2%) cases. Uterine filling defects were the most common uterine abnormality. Fallopian tube occlusion, loculated contrast material spillage and hydrosalpinx were more common on the right, and bilateral tubal occlusion was seen only in 11.2%. All cases of intravasation were associated with either unilateral or bilateral fallopian tube blockage or irregularity of the uterus.Conclusion:There was a high incidence of tubal disease in the women presenting with infertility. This was commonly as a result of infection and inflammatory process. This study showed that HSG is very vital in detecting birth canal pathologies; hence, the facility for this important procedure, especially fluoroscopy, should be made available in the health centres for adequate assessment of the women with infertility.

The relationship between hysterosalpingography findings and female infertility in a Nigerian population

“…Hysterosalpingogram has been used to assess fallopian tube obstruction, pelvic inflammatory disease-related adhesions, masses, cornual tubal blockage, and uterine lesions. It reveals abnormalities in the cervix, uterus, and fallopian tubes, and due to its low cost and non-invasive nature it is the first-line modality in many developing countries [2]. HSG can also be used to localise missing intrauterine devices (IUCD) in resource-poor settings [16].…”

“…Next, a Leech-Wilkinson cannula or an appropriate-size Foley catheter was inserted into the cervical Os and contrast was introduced into the uterine cavity to outline the cervical canal, uterine cavity, and the fallopian tubes. X-ray films were taken as the contrast medium filled the uterus and tubes [2]. Standard views taken included an anterior/posterior (AP) view of the pelvis, right and left lateral obliques, and a delayed film after 30 minutes when necessary.…”

“…Research has shown that child-seeking women aged 20-44 years in sub-Saharan Africa experienced higher rates of secondary infertility at 11.7% (9.9%, 13.4%) when compared to the international average of 10.5% (9.5%, 11.7%) [1]. While secondary infertility rates have declined in sub-Saharan Africa from 14.3% in 1990 [1], infertility remains an urgent problem, causing severe social, economic, and psychological problems in many local communities [2].…”

“…Hysterosalpingogram (HSG) is a valuable radiologic procedure utilised for assessing fallopian tube patency, as well as the morphology of the uterus and cervix [2]. HSG has a sensitivity of 94% and a specificity of 92% in detecting tubal blockage [6].…”

“…Once detected by HSG, many abnormalities will require follow-up evaluation or treatment with laparoscopy, hysteroscopy, or pelvic ultrasound [10]. Recent studies utilising HSG to evaluate secondary infertility in Nigeria reported tubal pathologies as the predominant finding, seen in 30-35% of patients, with others reporting uterine cavity abnormalities as the predominant finding in 50.8% [2,[11][12][13]. A prior study in the United Kingdom found an 8-24.5% frequency of uterine malformations in infertile and sterile patients compared to 5.5% in an unselected population [7].…”