Diagnostic value of hysterosalpingography and laparoscopy for tubal patency in infertile women

From deficiency to excess: the impact of iodine excess on reproductive health

Iodine is a critical trace element in the human body. It is primarily obtained through dietary sources such as dairy products, seafood, fish, eggs and certain vegetables. Iodine plays an essential role in various bodily functions, most notably in producing the thyroid hormones, triiodothyronine and thyroxine. Additionally, it influences the immune, cardiovascular, reproductive and gastrointestinal systems. Historically, iodine deficiency has been a significant global health issue; however, over the past decade, there has been a rise in iodine excess. This surge has been primarily attributed to inadequate monitoring and over-iodization of salt. Despite the well-documented consequences of iodine deficiency, the ramifications of excessive iodine intake remain underexplored. In view of rising global infertility rates, excess iodine has been linked to significant reproductive health effects. These include decreased sperm count, motility and morphology in males, as well as adverse pregnancy outcomes in females, such as maternal thyroid dysfunction and congenital hypothyroidism. This mini-review aims to collate and analyze current literature pertaining to the effects of iodine excess on reproductive health and shed light on its increasing incidence worldwide. Further research on the biological and clinical effects of iodine excess is required to derive a better understanding of this issue. Given the rising prevalence of iodine excess, it is crucial to raise awareness and implement proactive measures to prevent it from escalating into a major public health crisis in the future.

Diagnostic Approaches in Nuclear Medicine for Reproductive Health Assessment: Hysterosalpingography in Radiology versus hysterosalpingoscintigraphy

Background

Infertility is a significant aspect of reproductive health and evaluating degree of tubal pathology is essential for determining appropriate management plans.

Aims and Objectives

To assess the role of hysterosalpingoscintigraphy (HSSG) as a tubal patency test in nuclear medicine and compare it with hysterosalpingography (HSG) in radiology in infertile women and study pain perception in both tests as well.

Materials and Methods

A prospective study was conducted on 50 infertility patients undergoing infertility evaluation at a tertiary care hospital. Both HSG and HSSG procedures were performed during proliferative phase of menstrual cycle.

Results

Our study demonstrated the potential of HSSG as a tool for evaluating tubal patency in infertility workup. It showed good accuracy in detecting tubal patency compared to HSG.

Conclusion

HSG is a radiological procedure valued for its ability to provide detailed anatomical information of uterus and patency of fallopian tubes. In contrast, HSSG provides dynamic information on the functional aspects of the reproductive system using nuclear medicine techniques. Both HSG and HSSG are vital tools in the diagnostic armamentarium for assessing female reproductive health, offering complementary information that aids in comprehensive patient management.

The diagnostic value of hysterosalpingo-contrast sonography in female infertility of the fallopian tube

Objective

To explore the clinical diagnostic value of hysterosalpingo-contrast sonograghy (HyCoSy) in female infertility of the fallopian tube.

Methods

One hundred nineteen female infertility patients who underwent laparoscopy in Shenzhen Hospital of Beijing University of Chinese medicine (Longgang) and Longgang District People's Hospital of Shenzhen City from June 2019 to December 2021. Patients diagnosed with fallopian tube obstruction; 119 patients included 233 fallopian tubes (five patients had the affected fallopian tubes removed due to ectopic pregnancy) were selected for HyCoSy, and then the results of laparoscopic examination were taken as the gold standard for diagnosis. The authenticity of the diagnostic test was evaluated using four grid table data, and the consistency of the two diagnostic methods of hysterosalpingography and laparoscopy was compared by Kappa test.

Results

Of the 233 fallopian tubes assessed, 139 were unobstructed, 50 were blocked at the proximal end and 44 were blocked at the distal end by laparoscopy. The results of HyCoSy showed that 115 were unobstructed, seventy three was considered proximal obstruction and 45 were distal obstruction. When compared to laparoscopy, the accuracy of HyCoSy in the diagnosis of tubal patency, proximal obstruction and distal obstruction was 74.2%, 78.1% and 80.7%, respectively. Two methods had good consistency in the diagnosis of tubal patency (Kappa=0.486) and proximal tubal obstruction (Kappa=0.444), and poor consistency in the diagnosis of distal tubal obstruction (Kappa=0.375).

Conclusion

Laparoscopy and HyCoSy are both useful in the diagnosis and etiological analysis of female infertility. HyCoSy can be the first choice, those who have doubts about the screening results can actively carry out laparoscopy to further improve the accuracy of diagnosis and etiological analysis of this disease.

A meta-analysis of fertility and adverse outcomes in oil- and water-based contrast for hysterosalpingography

Infertility is the inability to conceive after one year of regular unprotected intercourse. There is a debate about the therapeutic effect of hysterosalpingography (HSG) and whether the selection of contrast materials makes a difference in the chance of subsequent conception. In this study, we aimed to compare the fertility-enhancing outcomes and adverse effects of oil and water-based contrasts in patients who underwent HSG. This systematic review and meta-analysis was conducted following the PRISMA guidelines. We searched the Web of Science, PubMed, and Scopus until September 2022. We included all primary randomized controlled trials evaluating the fertility-enhancing benefits of HSG in oil-based versus water-based contrast media in women of childbearing age with infertility. Eleven studies with 4,739 patients were selected. The pregnancy rate in the oil group was significantly higher than that in the water group [odds ratio (OR)=1.51 (1.23, 1.86), p<0.0001]. Our meta-analysis favored the oil group in abdominal pain and vaginal bleeding with the odd ratios of 0.73 (0.58, 0.91), (p=0.006) and 0.91 (0.46, 1.81), (p=0.79), respectively. Water-based contrast was associated with less intravasation [OR=2.09 (1.09-4.02), p=0.03]. There were no differences between the contrasts for miscarriage [OR=1.02 (0.71, 1.46), p=0.92], and ectopic pregnancy [OR=0.84 (0.27, 2.63), p=0.77]. HSG with oil-based contrast was related to a higher pregnancy rate, live birth rate, and intravasation rate. While HSG using a water-based contrast medium was associated with increased abdominal discomfort, vaginal bleeding, and the visual-analogue scale pain score.

Diagnostic laparoscopy prior to IVF cycle improves outcome in patients with unilateral distal tubal occlusion

OBJECTIVE

To assess the impact of laparoscopy before in vitro fertilization (IVF) treatment on live birth rates in patients with distal unilateral tubal obstruction (UTO).

METHODS

Retrospective cohort study which was conducted in tertiary ART center in Ankara University Hospital between January 2008- January 2019. Inclusion criteria were distal UTO at HSG, patients who were 18-40 years age and baseline serum FSH levels between 3-15 IU/ml. Exclusion criteria were patients who had previous tubal surgery and, hormonal dysfunction such as hyperprolactinemia or hypothyroidism at the time of the IVF cycle.

RESULTS

49 patients who underwent 117 IVF treatment cycles were included in the final analysis. Among those 17 patients (34 IVF cycles) in the study group who underwent laparoscopy prior to IVF cycles, and 32 patients (83 IVF cycles) in the control group who directly underwent IVF cycle with no prior laparoscopy. Eleven pathologies (64.7%) were detected and treated at laparoscopies of 17 patients with distal UTO. Both the clinical pregnancy and the live birth rates were also significantly higher in the study group when compared to the control group (29.4% vs. 12%, P=.031; 26.5% vs. 9.6%, respectively; P=.039).

CONCLUSIONS

Patients with distal UTO generally have a pelvic pathology and laparoscopy prior to IVF cycles can improve the treatment outcome.

Investigations and treatment offered to women presenting for infertility care in Harare, Zimbabwe: a cross sectional study

INTRODUCTION

clinical infertility is failure to conceive within a year of regular sexual intercourse by a non contracepting couple. Infertility care is costly and result in investigations being incomplete and inconclusive. It is therefore important to streamline investigations offered to infertile couples such that only the most cost effective tests are done. This paper explores the adequacy of investigations and treatments offered to women presenting for infertility care.

METHODS

the data used in this analysis was obtained from a cross sectional sample of 216 women who presented with infertility in public and private gynaecological clinics in Harare, Zimbabwe. Information on investigations and treatment offered to women presenting for care was extracted from hospital cards, case notes, laboratory and radiological reports. Data was analysed using STATA SE/15.

RESULTS

of the 178 (82.4%) who had ultrasound scan evaluation (USS) 50 (28.1%) had fibroids and 22 (12.4%) had polycystic ovaries. Tubal patency tests were done in 118 participants using (hystero-salpingogram) HSG alone in 62.7%, laparoscope and dye alone in 21.2% and both in 16.1% of them. Of the 97 (44.9%) men who had semen analysis 61 (62.9%) had abnormal parameters.

CONCLUSION

this study reveals that evaluation for tubal patency and USS to rule out reproductive organ pathology are not being offered to all women with a diagnosis of infertility. Likewise, male partner semen evaluation is not being done in all male partners. There is a high prevalence of abnormal semen parameters. Studies should be done to understand why some male partners are not forthcoming in providing semen for analysis. It is important for protocols to be produced by professional bodies which prescribe the minimum basic investigations in couples with infertility.

Comparison of Hysterosalpingography With Laparoscopy in the Diagnosis of Tubal Factor of Female Infertility

Background: Laparoscopy is considered to be the gold standard in the evaluation of causes leading to infertility. Hysterosalpingography (HSG) permits indirect visualization of the cervical canal, uterine cavity, and tube patency, which is helpful for evaluating the causes of infertility.

Objective: This study aimed to detect tubal abnormalities in infertile women by HSG or laparoscopy and determine the value of HSG in diagnosing fallopian tube status.

Methods: The study group consisted of 1,276 patients. HSG was performed as a preliminary test for the evaluation of fallopian tube status. Women were subjected to laparoscopic examination on evidence of HSG abnormalities.

Results: The negative predictive value of HSG for detecting patency or occlusion for the right/left tube was 92.08 and 95.44%, respectively. The kappa values for the consistent diagnosis in the right/left tube were 0.470 and 0.574, respectively. In cases of low patency of the right/left tube, there was a greater than a 40% chance for the tube to be patent, and the remaining high probability was pelvic adhesion. The positive predictive value of HSG for detecting patency or occlusion for both tubes was 87.2%. The kappa value was 0.898 [95% CI (0.838, 0.937), p < 0.001], which meant that the diagnostic accuracy of HSG for both tube patency/occlusion was explicit. The kappa value for the diagnosis of hydrosalpinx (especially for bilateral tube hydrosalpinx) was 0.838 [95% CI (0.754, 0.922), p < 0.001], and the diagnostic accuracy for HSG was 79.8, 67.9, and 72.4%, respectively.

Conclusion: The current study concluded that HSG is a good diagnostic modality to detect tube abnormalities in infertile patients. HSG and laparoscopy are complementary to each other and whenever the patient is undertaken for diagnosis of infertility. Cost-effective HSG had good predictive value in identifying tubal factor infertility.

Conventional and magnetic resonance hysterosalpingography in assessing tubal patency-A comparative study

Context:

Tubal factors, one of the leading causes of female infertility, have been conventionally evaluated by hysterosalpingography (HSG). The role of magnetic resonance imaging (MRI) in assessing female infertility is gaining importance because of its inherent efficiency in detecting structural abnormalities. Magnetic resonance hysterosalpingography (MR HSG) is less invasive and avoids exposure of ovaries to ionizing radiation. Its utility is extrapolated to visualize fallopian tubes.

Aims:

To assess the diagnostic accuracies of dynamic MR HSG and conventional HSG (cHSG) in identifying tubal patency in women with infertility using diagnostic laparoscopy (DL) as gold standard.

Materials and Methods:

A prospective study of 40 patients was conducted over a period of 6 months. The patients were subjected to MR HSG followed by cHSG during the preovulatory period. If tubes were blocked, the patients were subjected to DL in the next menstrual cycle. If the tubes were patent and there was failure of conception, they were subjected to DL in the interval of 3 months.

Results:

Twenty-four patients had bilateral tubal spill which was confirmed using cHSG and DL. One patient had discordant MR HSG and cHSG results and six patients had discordant MR HSG and DL results. No statistical difference was observed between MR HSG and cHSG.

Conclusion:

Pelvic MRI is an inevitable tool in infertility evaluation. MR HSG can be used in addition as it avoids exposure of the reproductive organs to radiation and has the same efficacy as cHSG.

Outcome of Laparoscopy in Infertile Couples attending a Teaching Hospital in Eastern Nepal: A Descriptive Cross-sectional Study

Introduction:

Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the outcome of laparoscopy in infertile females attending Nobel Medical College as laparoscopy is considered as a gold standard in investigation and treatment of infertility.

Methods:

A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology over a period of May 2018-April 2020, where the outcomes of laparoscopy in infertile females were studied. All the patients with abnormal HSG, unexplained infertility and adnexal mass in the background of infertility were enrolled.

Results:

Of the 100 infertile patients who underwent laparoscopy, 62 (62%) had evidence of tubal disease as documented by unilateral or bilateral block, 63 (63%) had peritubal adhesions and hydrosalpinx in 15 (15%). Associated pelvic pathology like endometriosis in 50 (50%) in the form of cyst, adhesions and complete and partial obliteration of Pouch of Douglas.

Conclusions:

Laparoscopy is definitely an effective diagnostic tool of tubal and pelvic pathology. Laparoscopy is recommended for all infertile females with suspected tubal factor and moreover it provides opportunity to correct the condition in possible cases.

Fluoroscopy: An essential diagnostic modality in the age of high-resolution cross-sectional imaging

The importance of fluoroscopy as an imaging modality has been minimized relative to other cross-sectional modalities, including high-resolution computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Fluoroscopy examinations have decreased in clinical practice due to reduced appreciation of its usefulness, insufficient training of residents, fewer staff with adequate expertise, and poor reimbursements relative to other modalities. We revisit and build upon the prior literature and history of this decreased utilization. We then seek to prove continued value, through categorized examples and within multiple subspecialties, wherein fluoroscopy plays an integral part toward clinical diagnoses as well as optimizing patient outcomes. This is particularly true for motility and esophageal disorders, where structure and function with real-time evaluation is essential.  We additionally show several post-operative cases where the synergy of fluoroscopy with CT and endoscopy is apparent.  The fluoroscopic radiologist also has the unique ability to vary patient positioning, as opposed to traditional CT or MRI, where orthogonal views are employed without positional or temporal changes. We turn attention to the modern era, with synergistic and novel cases demonstrating that fluoroscopy remains instrumental toward achieving a diagnosis alongside other modalities. Our cases stress the need to maintain expertise in fluoroscopy skill, and underline its continued importance in residency training programs.  We conclude that fluoroscopy is a relatively inexpensive modality that is often under-appreciated in diagnostic radiology. We suggest that competency in fluoroscopy is crucial for future generations of radiologists to both work with their peers, as well as to aid clinicians in the optimal treatment of patients.

Bilateral but not unilateral tubal obstruction is associated with positive chlamydia serology

Objective:

To assess the association between positive Chlamydia trachomatis (C. trachomatis) serology and unilateral or bilateral tubal obstruction.

Methods:

This was a cross sectional study that evaluated the association of positive C. trachomatis serology (Immunofluorescence Indirect Serology, IIF or Enzyme Immune Essay, EIE), in two infertile groups: A. 243 patients (27 with unilateral obstruction and 216 without it). B. 247 patients (31 with bilateral obstruction and 216 without it). The exclusion criteria were tubal ligation (tubectomy) and tubal surgery. The statistical test (SPSS 17.0) was the Chi-Square with a p=5%. Tubal obstruction was diagnosed through hysterosalpingography (HSG).

Results:

The mean age of the patients without obstruction was 33.6 years, SD 4.9. The mean age of the patients with unilateral obstruction was 33.7 years SD 4.9. The mean age of the patients with bilateral obstruction was 33.6 years, SD 4.9. There was no statistically significant difference between the age groups. In group A (unilateral obstruction versus serology) the Chi-Square was 0.02 (p=n.s.) and the Attributable Risk (AR) = 0.7%. In Group B (bilateral obstruction versus serology) the Chi-Square test was 9.87 (p<0.005) and the AR = 14.8%.

Conclusion:

This study found a strong and statistically significant association between bilateral tubal obstruction and C. trachomatis positive serology. The power of the test was 86%. There was no association between unilateral obstruction and positive serology.

Causes and Prevalence of Factors Causing Infertility in a Public Health Facility

Background:

Infertility causes change according to local demographics. There is thus the need to find the causes of infertility in context to local population to aid and direct management strategies accordingly.

Aims:

The aims were to study the causes of infertility and to calculate the proportion of the individual factors contributing to it in the population coming to a tertiary level public health facility. Setting and Design: This cross-sectional, observational study was done in an infertility clinic in a medical college and government hospital.

Materials and Methods:

The study comprised 120 couples who came for infertility evaluation and treatment. Cause of infertility in the couple was assigned on the basis of history and examination findings. The prevalence of each cause was evaluated.

Statistical Analysis:

Results were tabulated, and the prevalence of individual factors was calculated. Intratable analysis was done using SPSS 16.0.

Results:

Primary infertility (57.5%) was more prevalent than secondary infertility (42.5%). Female factor accounted for 46.6% of the cases with polycystic ovarian syndrome (PCOS) being the leading cause (46%). Infertility was seen equally in lean and obese PCOS cases. Infectious causes such as pelvic inflammatory disease and tuberculosis were significantly associated with tubal factor infertility (P = 0.001). Infertility causes changed as the age of marriage increased. In couples married for less than 5 years, PCOS was the main cause whereas later,male factor and unexplained infertility were the most common causes seen. Male factor contributed to 20% of the cases of infertility, and both tobacco and alcohol consumption were significantly associated with abnormal semen reports (P = 0.001).

Conclusion:

Causes of infertility vary according to the age of the couples and age of marriage. Although PCOS remains the main cause, infections are a major cause of tubal factor infertility, and tobacco and alcohol worsen the male factor. One-third of the cases still remain unexplained.

The validity of HSG in infertility work up

Background

Our purpose was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the diagnosis of the uterine cavity and tuboperitoneal abnormalities in infertile women. Reproducibility and consistency were also assessed. Two hundred infertile females underwent HSG, hysteroscopy, and/or laparoscopy as part of infertility workup. HSG examinations were retrospectively reviewed by three radiologists; we compared interobserver variability, and differences between the two results of reading the same examination after 3 months were compared to calculate intraobserver variability.

HSG sensitivity, specificity, PPV, NPV, and accuracy were calculated.

Results

The overall accuracy of HSG in diagnosing tubal, uterine cavity, and peritoneal abnormalities was 95.5%, 95%, and 89%, respectively (P value < 0.04).

HSG is reproducible in diagnosing normal versus abnormal examinations. Reproducibility in diagnosing uterine cavity, tubal, and peritoneal abnormalities was (ICC = 0.90), (ICC = 0.70), and (ICC = 0.31), respectively. Best agreement was seen in diagnosing luminal filling defect (sub mucous fibroid/polyp) (ICC = 0.90) (95% CI 0.86–0.98), whereas poorest agreement was found in diagnosing uterine adhesions (ICC = 0.13) (95% CI 0.10–0.13) and pelvic adhesions (ICC = 0.12) (95% CI 0.10–0.13) (P value < 0.03).

HSG consistency ranged from moderate to good (K = 0.49–0.79). It was highest in diagnosing normal versus abnormal examination (P value < 0.01); poorest in diagnosing pelvic adhesions.

Conclusion

HSG has high validity in negative results; it can minimize the use of invasive procedures. Laparoscopy is recommended in patients who had a pelvic disease or showing tubal obstruction on HSG.

Laparoscopic surgery: Any role in patients with unexplained infertility and failed in vitro fertilization cycles?

Patients who undergo several in-vitro fertilization (IVF) treatment cycles and fail to conceive present a frustrating problem to the clinician. When 1 cycle of IVF treatment fails, should we offer the couples to choose additional cycle of IVF instead of evaluation of the potential peritoneal factor? In cases of otherwise unexplained infertility, the investigation cannot be considered to be complete until laparoscopy has been performed. The aim of the study is to investigate the fertility outcome of laparoscopic treatment in infertile women with repeated IVF failures.This is a retrospective case-control study conducted in a tertiary care, academic teaching hospital from January 2012 to December 2015. Patients recruited in this study were classified into 2 groups. Study group (n = 45) were offered laparoscopy for evaluation of infertility, control group (n = 45) elected to proceed to IVF without laparoscopy. Diagnostic laparoscopy and subsequent excision of suspected endometriotic lesions, lysis of adhesion and treatment of tubal pathology were performed when indicated.Forty-four (97.8%) patients in study had pelvic pathologies and the treatment was performed at the same time. Twenty-four patients in study group conceived including 16 patients conceived spontaneously and 14 patients conceived with additional IVF following laparoscopy management. There was a significant difference in the ongoing pregnancy rates between patients conceived through IVF in study group and control group (41.9% vs 19.6%, P < .05).Laparoscopy in women with normal hysterosalpingography but recurrent IVF failures can detect unrecognized pelvic pathologies. Laparoscopy evaluation prior to additional cycle of IVF seems to improve the subsequent pregnancy rate.

Can hysterolaparoscopic mediated chromopertubation obviate the need for hysterosalpingography for proximal tubal blockage?: An experience at a single tertiary care center

OBJECTIVES

To compare the diagnostic performance for tubal patency by chromopertubation and hysterosalpingography in the female infertile patients.

METHODS

We prospectively evaluated 103 female patients (age range 19-35 years; mean age 27.60 years) diagnosed as infertile, underwent hysterosalpingography (HSG) for tubal patency and uterine pathology during initial diagnostic work-up. All the enlisted patients fulfilled the criteria of infertility and these also underwent hysterolaparoscopic chromopertubation (CPT). The results of HSG were compared with the reference standard using CPT.

RESULTS

Out of 103 female infertile patients, 60 (58.2%) were of primary and rest of them 43 (41.8%) secondary infertile patients. HSG showed abnormalities in tubal patency in 69/103 (∼67%) patients. The detected abnormalities were distributed in 40/60 (66.6%) primary and 29/43 (67.4%) secondary infertile patients. On comparison to HSG with CPT (reference standard) for tubal blockage detection, it was found that HSG was true positive (TP) in 38 patients, true negative in 34 patients, false positive in 31 patients and FN in 0 patients. We found that for detection of tubal blockage, the sensitivity, specificity, PPV, NPV and accuracy of HSG was 100.00%, 52.31%, 36.89%, 57.07% and 67% respectively. Tubal occlusion detected on HSG and CPT showed a moderate agreement (weighted kappa - 0.447; 95% CI -0.312 to 0.583). In present study, no patient shows tubal blockage in CPT while HSG was normal.

CONCLUSION

We concluded that hysterolaparoscopic mediated chromopertubation not only diagnostic but also therapeutic, so it can obviate the need of hysterosalpingography.

A new tubal classification system for fertility prognosis after laparoscopic salpingostomy for tubal pregnancy

OBJECTIVE

To assess the objectivity and accuracy of a new system that predicts the pregnancy outcomes in patients with tubal pregnancy after laparoscopic salpingostomy.

STUDY DESIGN

480 tubal pregnancy patients were retrospectively stratified as mild, moderate, or severe group according to the new tubal classification system in which pelvic adhesions, tubal morphology, structure, and patency were included. The follow-up was performed for 24 months to determine spontaneous pregnancy outcomes.

RESULTS

The tubal classification was significantly associated with intrauterine pregnancy rates (mild 70.9% vs. moderate 66.0% vs. severe 41.8%, P=0.001) and recurrent ectopic pregnancy rates (mild 2.8% vs. moderate 4.2% vs. severe 10.9%, P=0.047). The 24-month cumulative rate of intrauterine pregnancy was 73.5% in the mild group, 68.5% in the moderate group, and 45.8% in the severe group (P=0.002). The 24-month cumulative repeat ectopic pregnancy rate was 6.6% in the mild group, 9.1% in the moderate group, and 15% in the severe group (P=0.154). In Cox multivariate regression analysis, a lack of a history of infertility [hazard ratio (HR)=0.633, P=0.001] and tubal scoring (mild HR=2.408, P=0.008; moderate HR=2.147, P=0.010) were significantly associated with a higher rate of spontaneous intrauterine pregnancy. Having a history of infertility (HR=0.351, P=0.037) and no prior abdominopelvic surgery (HR=2.907, P=0.014) were significantly associated with a lower ectopic pregnancy rate.

CONCLUSION

The new tubal classification system significantly correlated with spontaneous pregnancy outcomes in patients with tubal pregnancy following laparoscopic salpingostomy.

Hysterosalpingographic findings among Ghanaian women undergoing infertility work-up: a study at the Korle-Bu Teaching Hospital

BACKGROUND

Hysterosalpingography (HSG) is one of the commonly used radiological modalities for investigating infertility in women. In developing countries such as Ghana it remains the main tool for investigating some of the underlying causes of female infertility. The purpose of this study was to determine the predominance of various hysterosalpingographic results in patients that went through infertility work-up at the Korle-Bu Teaching Hospital between January 2011 and December, 2014. This is to help plan for preventive measures for the communities.

RESULTS

This study collected retrospectively, 1140 consecutive radiologic reports from January 2011 to December, 2014 from the Department of Radiology, Korle-Bu Teaching Hospital. These reports were reviewed and diagnoses made were evaluated with Microsoft Excel. Secondary infertility was 52.4 % prevalent and primary infertility was 41 % prevalent. While 453 (39.7 %) patients presented with normal findings, 153 (13.4 %) had hydrosalpinx, 498 (43.6 %) had tubal blockage, and 290 (25.4 %) had fibroids. Also there were 10 (0.9 %) cases of patulous cervices, 8 (0.8 %) cases of uterine synechiae, 62 (5.4 %) of irregular uterine outline, 15 (1.3 %) of irregular cervical outline, 3 (0.3 %) of arcuate uteri, and 5 (0.4 %) cases of retroverted uteri.

CONCLUSION

Tubal blockage which presented in 43.6 % of patients was the most common abnormal finding at HSG examinations carried out between January 2011 and December, 2014 at the KBTH. This was followed by fibroids with 25.4 % and hydrosalpinx with 13.4 %. Factors such as chronic pelvic inflammatory disease or pelvic infection following STIs, mismanaged pregnancies and septic abortions, may have accounted for this since the majority of the women presented with secondary infertility.