A Review of Hysterosalpingographic Findings among Infertile Women in Delta State University Teaching Hospital in Southern Nigeria
Keywords:Review, HSG findings, infertile patient, DELSUTH, tubal blockages
Background: Infertility is a significant global public health challenge which negatively impacts on those affected. It is the main indication for hysterosalpingography (HSG) in contemporary gynecologic practice. HSG is a radiographic examination of the endocervical canal, uterine cavity and fallopian tube with the use of a contrast media, and it is commonly used in the evaluation of the female genital tract. The study was therefore conceptualized to document the uterotubal abnormalities in infertile female patients on HSG and correlate the findings with the types of infertility.
Materials and Method: This was a two year retrospective descriptive study conducted in the department of Obstetrics and Gynaecology of Delta State University Teaching Hospital (DELSUTH), between January 2012 and December 2013. The case files of 193 infertile women who underwent HSG were reviewed. The data was analyzed using the statistical package for the social sciences (SPSS PC+) version 19.
Result: The mean age of the patients was 34.8 ±5.8 years and the median age of patients was 33+ 5.87 years with a range of 22-48 years. Secondary infertility was commoner, accounting for 75.6% of the cases. Tubal abnormalities were the commonest abnormalities (48.5%) and uterine leiomyoma (24.9%) was the commonest uterine abnormality. Fifteen percent had right tubal occlusion, 14% had bilateral tubal occlusion, 7.7% had left tubal occlusion and 0.5% had tubal spasm. Previous surgical termination of pregnancy was majorly associated with secondary infertility and this was statistically significant (P-value=0.000).
Conclusion: Tubal factor remains a major cause of female infertility in southern Nigeria. Fallopian tubal blockage was the commonest genital tract structural abnormality observed on HSG while uterine fibroid was the commonest uterine pathology seen. Previous history of surgical termination of pregnancy was statistically significantly associated with secondary infertility.
Practice Committee of American Society for
Reproductive Medicine. Diagnostic evaluation of infertile female: a committee opinion. Fertil. Steril 2012; 98: 302.
Pundir J, Toukhy EI. Uterine cavity assessment prior to IVF.Women's Health (Lond Engl) 2010; 6 (6):841-848
Bello TO. Pattern of tubal pathology in infertile women on hysterosalpingography in Ilorin, Nigeria. Annals of African Medicine 2004. 3 (2): 77-79.
Adebiyi GA, Ameh CA, Eka A. Hysterosalpin gography tubal abnormalities and HIV infection among black women with infertility in Sub- Saharan Africa. Gynecol Obstet Invest 2008:66:119-122
Kanal P, Sharma S. Study of primary infertility in females by diagnostic laparoscopy. Internet Journal of Medical Update.2006.1 (2).
Streda R, Mardesic T, Kult D, Lazarovská S, Slámová J, Voboril J. The diagnostic value of hysterosalpingography in the diagnosis of tubal disease.Ceska Gynekol. 2009; 74(1):18-21.
Zvanca M, Vladareanu R, Andrei C. Infertility investigation through saline infusion sonohyst erosalpingography. Medica J Clin Med 2007; 2(1):10-7.
Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics 2009; 29 (5):1353-1370
Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K.MR imaging of disorders associated with female infertility: use in diagnosis, treatment, and management. Radiographics 2003; 23(6):1401-1421
Simpson WL Jr, Beitia LG, Mester J.Hysterosalpingography: a reemerging study. Radiographics 2006; 26(2):419-431
Mol BW, Collins JA, Burrows EA, van der Veen F, 70.
Bossuyt PMM (1999) Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod.1999; 14(5):1237-1242
Den Hartog JE, Lardenoije CM, Severens JL, Land JA, Evers JL, Kessels AG (2008) Screening strategies for tubal factor subfertility. Hum Reprod.2008; 23(8):1840-1848
Torre A, Pouly JL, Wainer B. [Anatomic evaluation of the female of the infertile couple]. J Gynecol Obstet Biol Reprod (Paris). 2010; 39(8 Suppl 2):S34-44.
Eng CW, Tang PH, Ong CL. Hysterosalpingo graphy: Current Applications. SingaporeMed J. 2007; 48(4): 368-73.
Karshima JA, Daru PA, Ekedigwe JE. Hystero salpingographic evaluation of 998 consecutive infertile women in Jos, Nigeria. Int J Gynecol Obst, 2010; 108(3): 255-257.
Balasch J. Investigation of the infertile couple: investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal Hum Reprod 2000; 15: 2251- 7.
Umar UA, Ibrahim SA, Omoloe-Ohonsi A, Yakassai IA. Comparative Evaluation of Tubal Patency; Hysterosalpingography versus laparoscopy. International Journal of Academic Research, 2011; 3 (4): 70-74.
Gokhan G, Gamze Y, Oznur G, Isin K, Lale W, Birol D . Hysterosalpingography, laparoscopy or both in the diagnosis of tubal disease in infertility. World Journal of Laparoscopic Surgery, May- August, 2008:1(2):23-26
Mesbahi S, Pourissa M, Refahi S, Tabarraei Y, Dehghan MH. Hysterosalpingographic abnormalities in infertile women.Research Journal of Biological Science. 2009; 4(4):430-432.
Ikechebelu JI, Adinma JIB, Orie EF, Ikegwuonu SO. High prevalence of male infertility in Southeastern Nigeria. Journal of Obstetrics & Gynaecology. 2003: 26(6): 657-659.
Shrivastava VR, Rijal B, Shrestha A, Shrestha HK, Tuladhar AS.Detection of tubal abnor malities by HSG in Nepalese subfertile women. Nepal Med Coll J 2009; 11(1): 42-45
Malwadde EK, Byanyima RK .Structural findings at hysterosalpingography in patients with infertility at two private clinics in Kampala, Uganda; African Health Sciences 2004; 4(3):178-
Myelene WMYao, Daniel JS. Infertility. In:Berek
Novak (ed.) Gynaecology (14th edition). Lipin-
cott, William and Wilkins 2007: 973-1067.
Ibekwe PC, Udensi AM, Imo AO. Hysterosal- 181.
pingographic findings in patients with infertility in south eastern Nigeria. Niger J Med. 2010; 19(2): 165-7.
Adrian C. Schankath, Nikola Fasching, Cornelia Urech-Ruh, Michael K. Hohl, Rahel A. Kubik- Huch. Hysterosalpingography in the work up of female infertility: indications, technique and diag- nostic findings. Insights Imaging (2012) 3:475-
Eleje GU, Okaforcha EI, Umeononihu OS, UdegbunamOI, Etoniru IS, Okwuosa AO. Hysterosalpingographic Findings among Infertile 483.
Women: Review at a Tertiary Health Care Institution in Nnewi, South-east Nigeria. AFRIMEDIC Journal 2012; 3(2).
Blumenthal NJ, Hertzanu Y ,Ferreira MMV, Mendelsohn DB, Godberger S. Hysterosal pingography in the assessment of infertility in black patients. South African Medical Journal, 1984; 65:854-856
Bello TO. Tubal abnormalities on hysterosalpin- gography in primary and secondary infertility. West Afr J Med .2006, Apr-Jun: 25(2):130-133
Eze CU, Ohagwu CC, Abonyi LC, Njoku J, Irurhe
Audu BM, Sa'ad ST and Tahi N. Role of hysterosal- pingography as a simple tool in the diagnosis of uterotubalcauses of infertility in a developing country setting. Niger J Clin Pract. March 2010; 13(1):7-12
Rajah R, McHuggo JM, Obhrai M. The role of hysterosalpingography in modern gynaecological practice .The British Journal of Radiology, 1992; 65:849-851
Shakya B .Hysterosalpingography Vs. Hyster oscopy in the detection of the intrauterine Pathology in infertility. Journal of Nepal Health
Res Counc, 2009, April; 7(14):6-9
Bonilla-Mosoles F, Simon C, Serra V, Sampaio M,
Pellicer A. An assessment of hysterosalping- osonography (HSG) as a diagnostic tool for uterine cavity defects and tubal patency. J Clin Ultrasound 1992; 20(3) :175-181
Perquin PAM, Dorr PJ, de Craen AJM, Helmerhost FM. Routine use of hysterosalpingography prior to laparoscopy in the fertility work up: multicenter randomized controlled trial. Human Reprod 2006; 21:1227-31.
Akinola RA, Akinola OI, Fabamwo AO. Infertility in women: Hysterosalpingographic assessment of the fallopian tubes in Lagos, Nigeria. Educational Research and Review. 2009; 4(3):086-089.
Rice JP, Hondou SN, Olive RL. Re- evaluation of hysterosalpingography in infertility investigations. Obstet Gynecol 1986; 67: 718 - 721.
Smiljami N, Ciglar S. Comparison of hysterosal- pingographic and laparoscopic find ings in tubal factors of sterility. Jugosl Gineko Opstet 1981; 21: 113-116.
Lees WR, Highman JH. Gynecological imaging. In: Sutton D (Ed.). Textbook of radiology and imaging. Churchill-Livingstone, Edinburgh.1998; 1 261-1269.
Dusak A, Soydinc HE, Onder H, Ekinci F, Görük NY, Hamidi C, Bilici A. Venous Intravasation as a Complication and Potential Pitfall During Hysterosalpingography: Re-Emerging Study with a Novel Classification. J Clin Imaging Sci 2013; 3:67.
Oyedeji O.A, J.A.O. Okeniyi, T.A. Ogunlesi, O. Onayemi, G.A. Oyedeji OAO. Parental Factors Influencing the Prevalence of Skin Infections and Infestations Among Nigerian Primary School Pupils - ISPUB. The Internet Journal of Dermatology.2006; 3(2).
Oguntoyinbo AE, Adesina KT, Olarinoye AO, Aboyeji AP, Olanrewaju WI, Oniyangi M. Pre- HSG microbial isolates from endocervical swabs in infertile women in Ilorin, Nigeria. West Afr J Radiol 2014;21:59-63
Karshima JA, Ekedigwe JE, Sagay AS. Cervical abnormalities seen at hysterosalpingogram of infertile women in Jos, North Central Nigeria. J Med Trop 2013; 15:117-20.
Imo AO, Sunday-Adeoye I. Radiological asses sment of the uterus and fallopian tubes in infertile women at Abakaliki, Nigeria. Niger J Clin Pract 2008;11:211-5
Santhalia PK,Gupta MK, Uprety, Ahmad K, Ansari S, Agrawal N, Rauniyar RK. Role of Radiographic Hysterosalpingography in Infertility in Eastern Nepal. NJR 2013; 3(4)
Mehmet N, Talip G, Ahmet E, Yusuf C. Comparison of hysterosalpingography and hysteroscopy in evaluation of infertile women. Saudi med j.2008;29(9): pp.1315-1318.
Famurewa O, Adeyemi A, Ibitoye O1, Ogun semoyin O. Association between history of abdominopelvic surgery and tubal pathology. African Health Sciences 2013;13(2).
Patil, M. Assessing tubal damage J. Jum Reprod Sci.,2009; 2: 2-11
Lash M.M. Yaghamee A., Strohsnitter W, Lal wani S. Association between secondary infertility and fallopian tube obstruction on hysterosalpingo- graphy. J Reprod Med.200 8;5(9):677-680.
Mard h PA , Wolner -Hanssen P. Periappendicitis and chlamydial salpingitis. Surg Gynecol Obstet 1985, 160:304-306.
Day B.D, Dunson D.B, Hill M.C.,Cousins D, Schetman J.M. High cumulative incidence of uterine leiomyoma in black and white women ultrasound evidence. Am J. Obstet Gynecol .2003; 1: 100-107.
Mgbor S.O .Pattern of hysterosalpingography finding in gynaecological patients in Enugu. Nig. Med. J; 47:14-16.
Ekpo E.U., Ikamaise V.C., Erim A. and Nnabuchi M.A. Nulliparity, Delayed Child Birth and Obesity: Potential Risk Factors for Development of Uterine Fibroid in South-South Nigeria/Journal of Association of Radiographers of Nigeria, 2009;23:23 29.
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The data collected from registered and non-registered users of this journal falls within the scope of the standard functioning of peer-reviewed journals. It includes information that makes communication possible for the editorial process; it is used to informs readers about the authorship and editing of content; it enables collecting aggregated data on readership behaviors, as well as tracking geopolitical and social elements of scholarly communication.
This journal’s editorial team uses this data to guide its work in publishing and improving this journal. Data that will assist in developing this publishing platform may be shared with its developer Public Knowledge Project in an anonymized and aggregated form, with appropriate exceptions such as article metrics. The data will not be sold by this journal or PKP nor will it be used for purposes other than those stated here. The authors published in this journal are responsible for the human subject data that figures in the research reported here.
Those involved in editing this journal seek to be compliant with industry standards for data privacy, including the European Union’s General Data Protection Regulation (GDPR) provision for “data subject rights” that include (a) breach notification; (b) right of access; (c) the right to be forgotten; (d) data portability; and (e) privacy by design. The GDPR also allows for the recognition of “the public interest in the availability of the data,” which has a particular saliency for those involved in maintaining, with the greatest integrity possible, the public record of scholarly publishing.