Evaluation of pattern of uterine and cervical abnormalities Potentially responsible for infertility in Zaria, Nigeria: hysterosalpingographic assessment

Abstract

Background:Structural abnormalities are amongst the important causes of female infertility. Hysterosalpingography (HSG) is an invasive but safe method of detecting both cervical and uterine pathologies. 

Objectives: The objective of this study was to determine the relationship between types of uterine and cervical abnormalities and fertility outcome.

Materials and Methods: A prospective study of 220 consecutive women who underwent hysterosalpingography using ionic water-soluble contrast media (urografin) between 1st December, 2011 and 31st May, 2013, at department of radiology, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Clinical notes and radiological findings were analyzed for demographic data and abnormal uterine cavity and cervical canal findings. Abnormal findings were correlated with treatments and fertility outcomes. Fertility outcome in women with normal and abnormal findings were compared. P- Value of less than 0.05 was considered as statistically significant. 

Results: The mean age and duration of infertility were 27.37years ± 4.50 and 4.48years respectively. Women with secondary infertility were 133 (60.50%) while 87 women (39.5%) suffered from primary infertility. The uterine cavity was normal in 167 (75.9%) of the women while 53 (24.1%) women had uterine cavity abnormalities; among these were 16 (30%) with primary infertility and 37 (70%) with secondary infertility. Cervical canal was normal in 210 (95.5%) of the women while 10 (4.5%) women had abnormalities among whom are 5 (50%) that suffered from primary infertility and 5 (50%) that suffered from secondary infertility. The fertility outcome after one year follow up showed 7 (11.1%) of the 63 patients with abnormal findings (cervical canal and endometrial cavity) got pregnant, while 25 (34.72%) of the 72 patients with normal findings (cervical canal, endometrial cavity, tubal and pelvic peritoneum) got pregnant. The difference noted was statistically significant (p – value = 0.001). High (12: 34.3%) spontaneous pregnancy rate was noted in patient with normal HSG, hormone and semen analyses. 

Conclusion: Fertility outcome among women with uterine cavity and cervical canal abnormalities but with normal hormone and semen analyses was low. The high spontaneous pregnancy rate in patients with normal HSG, hormones and semen analyses may be due to therapeutic effect of HSG.