Hysterosalpingogram findings among women with infertility in Ogun State, Nigeria

Background: Infertility is a relatively common health challenge in the society with social and psychological consequences. Hysterosalpingogram (HSG) is traditionally used to ascertain some of the causes of infertility. The use of ionizing radiation and contrast media injection with the possibility of complications, make new imaging modalities preferable, especially when in-vitro fertilization is being considered as a management option. Objective: To describe the pattern of the cervical, uterine, tubal and adnexial abnormalities causing infertility as detected by HSG in a tertiary health care institution, and demonstrate the prospects of retaining Hysterosalpingography in the investigation of female infertility. Methods: The HSG and reports of 124 patients referred to the Radiology Department of a tertiary health facility between January, 2013 and June, 2014, at a tertiary healthcare institution, were reviewed for abnormalities in the cervix, uterus, the fallopian tubes and adnexial structures. Results: Secondary infertility was the commonest indication for the procedure among in 66 of the 124 HSG reviewed. Pathologies in the cervix were found in 66 (51.6%) cases, of which the most frequent abnormality was cervical fibrosis in 59.4% (36/66) cases. Uterine abnormalities were found in 71.7% (89/124) cases, with uterine fibroid occurring in 82% (73/89) of these cases. Pathologies in the Fallopian tube occurred in 68 (54.8%) cases, with bilaterally blocked tubes occurring most frequently in 32.4% (22/68). Twenty-seven of the 68 cases (39.7%) with tubal abnormalities were aged 20-29 years. Conclusion: Secondary infertility was the commonest indication for HSG in the study, while uterine fibroid, cervical fibrosis and bilaterally blocked tubes were the most prominent findings in descending order of frequency. Therefore, caution should be exercised in managing pelvic infections, inflammations, diagnostic dilation and curettage and post-abortal and post-surgical periods in order to reduce the risk of fibrosis