Hysteroscopic characterization and classification of intrauterine adhesions among infertile Nigerian women

Abstract

Background: There is paucity of data on the application of hysteroscopy in the management of intrauterine adhesions in Nigeria.

Objective: To describe the hysteroscopic characterization and classification of intrauterine adhesions seen among infertile Nigerian women managed at the Fertility and Endoscopy Units of Nnamdi Azikiwe University Teaching Hospital Nnewi and Holy Rosary Specialist Hospital Onitsha, Nigeria.

Methodology: This is a prospective study. A proforma was used to document intra uterine adhesion findings at hysteroscopy and the collected data were analyzed with STATA software, version 12.0 SE. The ASRM Grading system was used to define the severity of the lesions.

Results: Seventy six (47.8%) out of 159 infertile women managed during the period had intrauterine adhesions. The age range of the women was 26-43 years (mean 34.8±5.1) and the mean parity was 0.75± 1.03. Fifty six (73.7%) of the women had secondary infertility and abnormal menstruation was found in 47(61.8%).

Adhesions were mainly multiple (88.2%; n=67) and of a combined dense and filmy types (39.5%; n= 30). Obliterative lesions were found in 44(57.9%) while in 10(13.2%) women, it was obstructive. The uterine cavity was partially involved in 48(63.2%) of the women and completely in 19(25.0%). The tubal ostia were involved in 47(61.8%) of the cases. The left ostium was not visualized in 18(23.7%) cases and the right ostium in 22(29.0%) cases. The cervical os was involved in adhesion in 26(34.3%) cases and was completely occluded in 16(21.1%) cases. Severe adhesion was seen in 19(25.0%) of the women.

Conclusion: The intrauterine adhesions among the studied women were mainly mild and moderate in severity, multiple, obliterative and of a combined dense and filmy nature.

Keywords: Adhesiolysis, Hypomenorrhoea, Amenorrhoea, Infertility, Endometrial lesions