Hysterosalpingography (HSG) findings: Of infertile patients in Ilorin

Abstract

Purpose/Background: Infertility is a major gynecological complaint in Nigeria, constituting about fifty percent (50%) of gynecological clinic attendance1-3. Hysterosalpingography (HSG) is used as a first line investigative procedure for evaluating infertility cases. An analysis of HSG findings of patients with primary and secondary infertility problems was done to sensitize the patients as well as the physicians to the benefits and value of this investigation. The study Design was prospective starting from January 2009 to January 2011. HSG findings of patients, who were being investigated for infertility, were documented after each examination on
duplicate forms before the results were sent out. The setting was in a private medical diagnostic centre in Ilorin Metropolis. All prospective patients consented to the examination and were mostly referrals from other medical centers around. Each patient was given an antispasmodic injection, before each examination, in-order to eliminate false or physiological fallopian tube blockage due to tubal spasm. The following
variables were later analyzed: Age of patient, type/duration of infertility, patency or blockage of the fallopian tubes (and the side that was blocked); presence of fibroids, adhesions and hydrosalpinx.
Results: Of the 100 records analyzed, 93 (93%) had abnormal findings and 7 (7%) were normal. The age range was between 20 and 48yrs with a mean of 32.14yrs and mode of 30yrs. Majority of the cases of infertility were of less than 5yrs (55%), followed by those lasting between 6 and 10yrs (19%). Thirty-seven percent (37%) of the patients (constituting the majority) were engaged in trading and 3 business ventures; followed by those engaged in teaching profession (14%) and the civil servants (13%) respectively. Secondary infertility (58%) was more common than the
primary infertility cases with 38 (38%), while 4 cases (4%) were unidentified. Concerning frequency of tubal pathology, single fallopian tube blockage, (SFTB) was the highest; with 45 cases (45%) while double tube blockage (DFTB) came second with 36 cases (36%), the remaining 19 cases (19%) had bilateral FP patency (BFTP). However when selectively evaluated for individual pathology, tubal patency (TP) was more frequent on the right side (20%) than on the left side (12%). And out of the lots (100 cases), Twenty-nine (29) of them, were found to have partial tube patency or were recorded as having forced spillage usually through a
hydrosalpinx (es). A higher percentage (42.11%) of the patients (pts) with primary infertility had bilateral tube blockage (BTB), 16 out of 38, compared to (32.75%), 19 cases from 58 in those with secondary infertility. Also the number of primary infertile pts with SFTB was 20, compared to 23 cases from secondary infertility cases, almost at par.
Another finding was that a very low percentage of the primary infertility (PI) cases had bilateral tube patency (BTP), 2 cases (5.26%) only, compared to 16 cases (27.59%) from secondary infertile (SI) group. In terms of association, out of 77 cases that had either pelvic or cervico-uterine adhesions, only 15 of them exhibited bilateral patency of their fallopian tubes.
Conclusions: A very low percentage of the primary infertility cases had bilateral tube patency, 2 (5.26%) in this study, compared with 16 (27.59%) in secondary infertile cases. It is suggested that the investigation is needed by infertile couples, especially primarily infertile patients.Secondly a greater proportion of the women seeking solution for infertility had anomalies or pathological findings that can be identified on HSG and these will help the physician to determine the next line of treatment for such cases.

Keywords: Female infertility, HSG, benefits and
findings, Ilorin