Endometrial sampling in infertility: the Ilorin, Nigeria, experience

Abstract

Infertility, the inability of a couple to achieve pregnancy after 12 months, of regular, adequate and unprotected sexual intercourse constitute about 50% of cases seen in most gynaecological clinic in developing countries. This is often associated with pathological lesion of the endometrium. The aim of this study is to determine the diagnosis value of endometrium sampling in detecting endometrial pathology and presence or absence of ovulation in infertility patients. A retrospective study of endometrial tissues histopathological slides of infertility patients as recorded in the register of the department of Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria between January 1,1997 and December 31,2001. The prevalence rate of normal and other endometrial pathology expressed in percentages. Five hundred and sixty three (563) endometrial sampling slides representing 52% of the total endometrial sampling were indicated for infertility patients. Out of these, 494 patients were included in the study. Majority of the studied group 195(39.5%)were aged 26-30years, Primary infertility constituted 31.5% of cases while secondary infertility constituted 67%. In 1.8% of cases indications were not specified. Four hundred and seventy –six (476) of the studied patients had normal phase and endometrium with majority, 427(89.7%) being in secretory phase and 49(10%) in proliferative phase. Eighteen (18) patients representing 3.56% of the studied group had endometrial abnormalities. These included chronic non-specific endometritis (27.7%), hormonal imbalance (33%), endometrial hyperplasia (17%) and tuberculous endometritis (11%). Others include sub mucous leiomyoma (6%) and well-differentiated adenocarcinoma (6%). The diagnostic value of endometrial sampling in infertility lies in detecting endometrial pathology and presence or absence of ovulation. This can be improved on through detailed and correct completion of request forms by clinicians coupled with endometrial culture and immunohistochemical techniques when necessary. Also, the fact that majority of our patients (89.7%) were in normal secretory phase, which is indicative of adequate ovulatory function has brought to fore, “the value of routine endometrial biopsy” for evaluation of infertility in this environment where more than 50% of cases of infertility are due to tubal factor. There may be a need to adequately select the patients that would benefit from it.

Nigerian Medical Practitioner Vol. 50(1) 2006: 15-18