Complementary roles of hysterosalpingography and transabdominal ultrasonography in the assessment of the uterus among women with infertility in a developing nation

Abstract

Background: The uterus plays a vital role in female infertility. In our environment, it is commonly separately examined with either transabdominal ultrasonography (TAUS) or hysterosalpingography (HSG) which are cheap and readily available. A concurrent use of the two procedures might have a complementary effect with a good outcome especially in a developing economy where three dimensional (3-D) ultrasound, sonohysterography and magnetic resonance imaging (MRI) which are more sensitive are neither readily available nor affordable.
Objectives: To document the uterine, tubal and adnexal lesions diagnosed using each of the two procedures and to check if the procedures can complement each other in a poor resource economy.
Methodology: This is a six month, paired group and analytical observational study of 200 women with infertility. HSG was booked in keeping with the ten-day rule and TAUS was performed on the same day before HSG. Statistical Package for Social Sciences, version 21 was used for the analysis. Ρ ≤ 0.05 was considered statistically significant.
Results: With TAUS evaluation, 158(79%) of the subjects appeared normal. Fibroids were detected in 39(19.5%) subjects, and in 37(94.9%) of this subset, they were localized. Intrauterine adhesions were seen in 0(0%), endometrial polyp in 1(0.5%), and endometrial hyperplasia in 2(1%). With HSG, 149(74.5%) appeared normal. Fibroids were detected in 27(13.5%) and in 19(70.4%) of this subset, they were localized. Intrauterine adhesions were seen in 23(11.5%), endometrial polyp in 1(0.5%) and endometrial hyperplasia in 0(0%). With HSG, tubal occlusion was seen in 63(31.5%), peritubal adhesions in 34(17%), hydrosalpinges in 5(2.5%) and loculated spill in 7(3.5%). None of these were seen with TAUS. With TAUS adnexal masses were in 12(6%) and with HSG they were demonstrated in 2(1%). There was significant difference between TAUS and HSG findings with regard to detection of fibroids, localization of fibroids, detection of tubal lesions and detection of adnexal lesions.
Conclusion: The two modalities played important complementary roles since TAUS was able to detect more lesions on the wall of the uterus and in the adnexae, while HSG was able to detect more intracavitory and tubal lesions. The combined study is recommended especially in a poor resource economy where other more sensitive modalities are neither available nor affordable.