Key Features:
- No of Pages: 88
- No of Chapters: 05
Introduction:
Abstract
Standardized and comprehensive hysterosalpingography and ultra-sonography has become an important tool in medical imaging approaches that constitute the mainstay of investigating female patients presenting with infertility. A retrospective study was carried out to evaluate the common radiographic and ultrasound findings in female patients with infertility using hysterosalpingographic and ultrasound screening 186 cases were conveniently selected from the records of hysterosalpingography and ultrasound examinations. Descriptive method of analysis was used to analyze the data. The frequency of patients referred for ultrasound screening was significantly more than those referred for HSG screening (n=84 Vs n=24; p<0.05). Age group between 30 to34 years and 35 to 39years had the highest frequency of referral to ultrasound and HSG respectively. The commonest reason for referral of patients with infertility for both ultrasound and HSG evaluation was secondary infertility. Uterine leiomyoma (38.6% n=68) and tubal blockage (24.8% n=34) were the ultrasound and HSG commonest findings in the evaluation of patients with infertility.
The result of this study showed that the commonest ultrasound and HSG findings were uterine leiomyoma and tubal blockage respectively. Both findings had no significant difference in the proportion of their occurrence in each of the grouping of infertility. The result also showed that the commonest reason for referral of patients with infertility for both ultrasound and HSG evaluation was secondary infertility and the commonest age group referred for both ultrasound and HSG evaluation was 30-34years and 35-39years respectively.
Keywords: infertility, ultra-sonography, hysterosalpingography, referral, findings, UNTH Ituku/Ozalla.
Table of Content
Title Page - - - - - -i
Approval Page - - - - - ii
Certification - - - - - -iii
Dedication - - - - - -iv
Acknowledgement - - - - - -v
Abstract - - - - - -vi
Table of contents - - - - - -vii
List of figures - - - - - - -xii
List of table - - - - - - -ix
CHAPTER ONE
1.0 Introduction - - - - - -1
1.1 Statement of problem - - - - - -4
1.2 Purpose of study - - - - - -4
1.3 Significance of study - - - - - - -5
1.4 Scope of study - - - - - - -5
1.5 operational definition of terms- - - - - -5
1.6 Literature review - - - - - -7
CHAPTER TWO
2.0 Theoretical background - - - - -15
2.1 Brief anatomy of the female reproductive system - - -15
2.2 Brief physiology of the female reproductive system - - -18
2.3 Overview of the evaluation of female infertility - - -20
2.4 Radiographic evaluation of female infertility- - - -23
2.4.1 Principle of ultrasound - - - - - -23
2.4.2 Ultrasound in the initial evaluation of infertility - - -24
2.4.3 Hysterosalpingography techniques - - - - -30
2.4.5 HSG in evaluation of female infertility - - - -34
CHAPTER THREE
3.0 Research Methodology - - - - - -40
3.1 Research Design - - - - - -40
3.2 Target population - - - - - - -40
3.3 Sampling - - - - - - - -40
3.4 Sources of data - - - - - -40
3.3 Method of data collection - - - - - - 41
CHAPTER FOUR
4.0 Data analysis - - - - - - -42
4.1 Presentation of data - - - - - - -42
CHAPTER FIVE
5.0 Discussion - - - - - -51
5.1 Summary of findings - - - - - - -53
5.2 Recommendation - - - - - -54
5.3 Limitations - - - - - -54
5.4 Area of further study - - - - - - -54
5.5 Conclusion - - - - - -55
References- - - - - - - - - -56
Appendix
LIST OF FIGURES
Figure. 1 female Reproductive system - - - - - -16
Figure. 2 Anatomy of female Reproductive system- - - - - -20
Figure. 3 Intramural leiomyomata are frequently visualized- - - -28
Figure. 4 Adenomyosis.- - - - - - - - -29
Figure. 5 Normal ovary during a natural menstrual cycle - - - -30
Figure. 6 Failure of ovulation and development of “cystic” follicle - - -31
Figure. 7. Images from women with polycystic ovary syndrome - - -31
Figure. 8. Images of a small intraovarian dermoid cyst - - - -32
Figure .9 Images of ovarian endometrioma- - - - - - -32
Figure. 10 Normal hysterosalpingogram - - - - - -37
Figure 11 Bicornate uterus, didelphys uterus, unicornate uterus, arcuate uterus -38
Figure . 12 Submucosa fibromyoma - - - - - - -38
Figure . 13 Hysterosalpingogram showing hydrosalpinx - - - -39
Figure . 14 Ultrasound images of hydrosalpinx - - - - -39
Figure . 15 hysterosalpingogram showing tubal irregularity - - - -40
Figure . 16. hysterogram showing peritubal abnormality- - - - -41
Figure.17.Uterine synechia appear as irregular linear filling defects at hysterosalpingography- - 42
Figure. 18 Sagittal image from transvaginal hysterographic US shows multiple uterine synechiae- - -47
Figure 19: The pie chart above demonstrates major groupings of clinical indications for ultrasound in female patients presenting with infertility- -47
Figure 20: The pie chart above demonstrates major groupings of clinical indications for HSG in female patients presenting with infertility- -49
LIST OF TABLES
Table 1: Age distribution of patients that underwent infertility screening between January 2012 – January 2013- -45
Table 2a: Distribution of the patients that underwent ultrasonography for infertility evaluation according to age and clinical indication-46
Table 2b: Distribution of the patients that underwent hysterosalpingography for infertility evaluation - 48
Table 3a: Distribution of ultrasound findings according to patient’s age - -- -50
Table 3b: Distribution of hysterosalpingographic findings according to patient’s age -51
Table 4a: Distribution of ultrasound diagnosis (findings) in patients with infertility in relation to the clinical indications-52
Table 4b: Distribution of HSG diagnosis (findings) in patients with infertility in relation to the clinical indications -53
Introduction
Infertility is a disease of the reproductive system which affects both men and women with almost equal frequency .1 it is a unique medical condition because it involves a couple, rather than a single individual. Infertility is a disease that results in the abnormal functioning of the male or female reproductive system. The American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) recognize infertility as a disease.2
While there is no universal definition of Infertility, a couple is generally considered clinically infertile when pregnancy has not occurred after at least twelve months of regular unprotected intercourse.3 Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term. Infertility is a common condition with psychological, economic, demographic and medical implication. It is not only a medical but also a social problem in our society as cultural customs and perceived religious dictums may equate infertility with failure on a personal, interpersonal, or social level. Women bear the brunt of these societal perceptions in most of the cases. Psychologically, the infertile woman exhibits significantly higher psychopathology in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation.4
It is estimated that as many as 15% of married couples are affected by fertility disorders. The number of such couples seeking medical help has increased dramatically in the past 10 years due to both relative and absolute factors.5 In a World Health Organization (WHO) study of 8500 infertile couples, female factor infertility was reported in 37% of infertile couples in developed countries, male factor infertility in 8% and both male and female factor infertility in 35%.6 the remaining couples had unexplained infertility or became pregnant during the study.
The fertility rate in a couple is influenced by several factors. These include: the age of the female partner, the age of the male partner, exposure to sexually transmitted diseases, exposure to environmental and medical toxins, coexistent disease states and specific disorders. The most common identifiable female factors, which accounted for 81% of female infertility are: ovulatory disorders (25%), endometriosis(15%), pelvic adhesions(12%), tubal blockage and other tubal abnormalities(11%), hyperprolactinemia(7%).7 Cervical factors, genetic causes, uterine factors, immune factors, lifestyle factors are also factors that contribute to female infertility. Male infertility has been identified to be associated with oligozoospermia (decrease in number of sperm cells in the ejaculate compare to reference range) or azoospermia (no sperm cell in the ejaculate). Over 80% of men with infertility have low sperm concentrations associated with a decrease in sperm motility (asthenozoospermia) and spermatozoa with normal morphology. Others may have a decrease in sperm motility and abnormal sperm morphology (teratozoospermia). Other factors include: congenital disorders, acquired diseases (such as tumor, infection, smoking, vascular lesion etc), obesity etc.7
The most important goal of fertility investigation is to identify the cause(s) of infertility and to prescribe adequate therapy. An infertility evaluation is usually initiated after one year of regular unprotected intercourse in women under age 35 and after six months of unprotected intercourse in women age 35 and older. However, the evaluation may be initiated sooner in women with irregular menstrual cycles or known risk factors for infertility, such as endometriosis, a history of pelvic inflammatory disease, or reproductive tract malformations. The diagnostic evaluation, therefore, must include both partners and couple should be investigated as a single unit as each partner contributes a share to the infertility potential of the couple. Evaluation should begin with the taking of a detailed history and a complete physical examination of both partners, which may point the investigation in a particular direction.
With unwanted infertility on the rise, the radiology department is becoming increasingly involved both in the diagnosis and treatment of these patients. Assessment of the six most common factors causing infertility should be performed during the initial clinical evaluation. These six factors include the cervical factor, endometrial-uterine factor, tubal factor, ovarian factor, peritoneal factor, and male factor.8 Standardized and comprehensive radiographic and ultra-sonographic approach to the investigation of infertility constitute the mainstay of the evaluation of the female member. Although newer diagnostic techniques such as MRI and selective fallopian tube catheterization seem to have important emerging role, hysterosalpingography and diagnostic ultrasound still play major roles in evaluation of female infertility.
However, this research work will give detailed analyses of the common hysterosalpingographic and ultrasound findings in patients presenting with infertility and relate the findings with their clinical indications and age distributions. It will elucidate the prevalence of occurrence of the major common findings of these infertility screenings.
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