Hysterosalpingography in the evaluation of infertility: a five years review. (FGAE, 2001 -5).

BACKGROUND

Internal genital occlusion, mainly the fallopian tubes, secondary to pelvic inflammatory disease, is the most common causes of female infertility in sub-Saharan Africa and hysterosalpingography is a common diagnostic modality.

OBJECTIVE

This was to discuss the findings of HSG and compare among primary and secondary infertility.

PATIENTS AND METHODS

All infertility clinical records of five years (2001-2005) at FGAE central clinic were retrieved and those women who had undergone HSG procedure selected. The type and duration of infertility, socio-demographic factors and the recorded results of HSG were analyzed.

RESULTS

Among the total of 8582 attendants of the infertility clinic, 96% were women and 4% males. HSG was undertaken on 1716 (21%) women. Secondary and primary infertility were 894 (53%) and 804 (47%) respectively. Addis Ababa residents were 84%; married 93%; house wives 61% and office workers were 25%. About 39% (n = 662) of the women came to the clinic for investigation after 30 years of age and 42% (n = 714) after five years duration of infertility. There were 55% (n = 934) with secondary and above level of education while 10% had no formal school. Normal HSG was 604 (36%); significantly more in primary than secondary (p = 0.0002). The uterine cavity was normal in 1253 (73%) of which 21% had bilateral tubal blockage while among the abnormal, 44% showed bilateral block (P = 0.0000000). Tubal abnormalities were significantly associated with the acquired uterine defects than that of the 2.8% congenital uterine abnormalities. Of the 847 (49%) bilateral tubal patency, 14% had luminal defects. Unilaterally patent tubes were demonstrated in 324 (19%) women: more in secondary type (p = 0.0001) without significant difference between the right and the left. Bilateral tubal obstructions were noted in 527 (31%) of which 25% were symmetrical and 6% asymmetrical. Of the blocked tubes, the sites were 60% terminal and 37% proximal.

CONCLUSION

The review showed that most of the HSG were abnormal commonly tubal blockage: significantly more in secondary than primary infertility. End block was the commonest site and is associated with hydrosalpinx. The association of acquired uterine and tubal defects and secondary infertility is indicative of damage of internal genital tract following the previous pregnancies. Though applicable also to the primary infertility group, other infections (STI, TB) may contribute to the damage.