Pelvic sonographic and hysterosalpingographic findings among women with secondary infertility in Kawempe – Mulago National Referral Hosp

Abstract

Background: Infertility is an increasing concern in the spectrum of reproductive health diseases especially in developing countries attributed to increasing rates of PID. Pelvic USS and HSG are the most frequently requested imaging investigations in the work-up for infertility in Uganda. Despite the technological advances in USS and fluoroscopy, there is paucity of information on the current trends of radiological findings for secondary female infertility in Uganda.

Objective: To describe the pelvic sonographic and HSG findings among women with secondary infertility in Kawempe – MNRH.

Materials and methods: This cross sectional study was conducted in Kawempe - MNRH in Kampala on 138 secondary infertility participants with each undertaking a pelvic USS (trans- abdominal and trans-vaginal) and an HSG. This totaled to 138 examinations carried out between January 2019 and July 2019. The obtained demographic data and radiological findings were reviewed and the data analyzed with SPSS version 15.

Results: A total of 138 participants underwent pelvic USS and HSG. The average age was 27 years and the most frequent age-group was 26-30years. The commonest abnormal HSG findings included bilateral tubal blockage (51.89%), unilateral tubal blockage (42.45%) and peri-fimbrial adhesions (16.98%). The commonest pelvic sonographic abnormalities included: PID sequelae (33.9%), PCO (32.2%) and leiomyomas (29.42 %). Among the 79 participants that had normal pelvic USS findings (57.25%), 32 (23.19 %) of these had normal HSG findings, 26 (18.84%) had bilateral tubal blockage and 21 (15.22%) had unilateral tubal blockage. Among the 32 participants that had normal HSG findings, 23 (16.67%) participants had normal USS findings, 7 (5.07%) participants had PID sequelae and both PCO and ovarian cysts each had 1 (0.72%) participant. PID sequelae were the commonest pelvic USS pathology. Similarly, its sequelae on HSG (tubal blockages, peri-fimbrial adhesions, uterine synechiae) dominated among the HSG anomalies. Of the 20 participants that had PID on pelvic USS, 9 participants (6.52%) had bilateral tubal blockage, 7 participants (5.07%) had unilateral tubal blockage and 2participants (2.9%) had normal HSGs.

Conclusion: PID is still the leading cause of secondary infertility. Pelvic sonography has higher potential in diagnosing cervical, uterine and ovarian pathologies as compared to HSG which is superior in detecting and characterizing tubal pathologies. Recommendation: HSG and pelvic USS provide complimentary findings about the different parts of the female genital system hence both should be done in the assessment of every secondary infertility patient.