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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 89-92

Uterine and tubal abnormalities in infertile Saudi Arabian women: A teaching hospital experience


1 Department of Obstetrics and Gynecology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al Khobar, Saudi Arabia
2 Department of Radiology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al Khobar, Saudi Arabia

Date of Web Publication9-Mar-2016

Correspondence Address:
Haifa A Al-Turki
King Fahd Hospital of the University, P.O. Box 40286, Al Khobar 31952
Saudi Arabia
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DOI: 10.4103/1658-631X.178293

PMID: 30787704

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  Abstract 

Background and Objective: Hysterosalpingography (HSG) is commonly used in the evaluation of the subfertile and infertile women. This study was undertaken to assimilate the findings observed during HSG in Saudi Arabian infertile patients and to find the most common pathology identified by the HSG.
Patients and Methods: A retrospective analysis was conducted of subfertile and infertile patients who had undergone HSG between June 2007 and May 2012. Patients' demographic data were collected from the medical records of the King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The data included age, years of marriage, menstrual history either regular or irregular, primary/secondary infertility, hormonal profile, previous infection or pelvic surgery, and diagnostic laparoscopy. Radiographic reports of HSG were collected from the IPAC system and analyzed for fimbrial findings, tubal patency, and cervical and uterine cavitary pathology. The data were entered in the database and analyzed using a t-test to compare means between the age, type of infertility, different pathologies and for all the parameters assessed. All tests were performed using Statistical Package for the Social Sciences, version 14.0, Chicago, Illinois, USA. A P < 0.05 was considered statistically significant with a confidence interval of 95%.
Results: Data from the medical records of 117 patients with an average age of 32.59 ± 5.48 years were analyzed. Of this total, 48 (41%) had been diagnosed as having primary infertility. In 95 (81.2%) patients, there was an abnormality in the fallopian tubes and in 27 (23%) patients, there was an abnormality in the uterus. Patients with primary infertility were significantly younger (29.7 ± 5.6 vs. 34.58 ± 4.75; P < 0.001), and tubal and uterine pathology was more common (P < 0.08 and 0.01).
Conclusions: Our review indicates that the most common pathology found through HSG in women presenting with infertility is tubal blockage.

  Abstract in Arabic 

ملخص البحث :

تستخدم أشعة الصبغة الرحمية لتقييم السيدات اللواتي يعانين من تأخر الحمل. أجريت هذه الدراسة لمقارنة النتائج الملحوظة في أشعة الصبغة الرحمية لدى السيدات السعوديات اللاتي يعانين من تأخر الحمل. هذه دراسة إسترجاعية لهؤلاء السيدات اللاتي اخضعن لهذا الفحص وذلك في الفترة مابين يونيو 7002 ومايو 2102. وتم الحصول على المعلومات من الملفات الطبية والتي شملت العمر وعدد سنوات الزواج وتاريخ الدورة الشهرية وتأخر الحمل وتحليل الهرمونات وعن وجود التهابات سابقة بالحوض. تضمنت الدراسة 117 سيدة بمتوسط عمري 23 سنة. تم تشخيص تغيرات مرضيه في قناة فالوب لدى %18 من المريضات، بينما %32 منهن كن يعانين من عيوب رحمية. وكانت السيدات اللاتي يعانين من تأخر الحمل الأولي اصغر عمراً. خلصت هذه الدراسة إلى أن معظم حالات تأخر الحمل كانت بسبب انسداد في قناة فالوب.

Keywords: Fallopian tubes, infertility, uterus, Saudi Arabia


How to cite this article:
Al-Turki HA, Gullenpet AH, Syed A, Al-Saif HS, Aldhafery BF. Uterine and tubal abnormalities in infertile Saudi Arabian women: A teaching hospital experience. Saudi J Med Med Sci 2016;4:89-92

How to cite this URL:
Al-Turki HA, Gullenpet AH, Syed A, Al-Saif HS, Aldhafery BF. Uterine and tubal abnormalities in infertile Saudi Arabian women: A teaching hospital experience. Saudi J Med Med Sci [serial online] 2016 [cited 2021 Mar 7];4:89-92. Available from: https://www.sjmms.net/text.asp?2016/4/2/89/178293


  Introduction Top


The worldwide incidence of infertility is reported in the range of 8-12% and approximately another 15% of couples remain subfertile. [1],[2] In 50% of couples who are infertile or subfertile, the cause of the infertility or subfertility is attributable to female factors; however in up to 20% of cases, the reason for the subfertility remains unexplained. [3] Information regarding infertility in the Saudi Arabian population is limited. Blood investigations are routinely conducted as a baseline in women who are undergoing fertility treatment assess ovulation, which is dependent on hormonal levels of follicle stimulating hormone, luteinizing hormone, progesterone level. In addition, a hysterosalpingogram (HSG) is routinely conducted to check tubal patency and uterine cavity abnormalities which are reported to be the cause of infertility and subfertility in 50% of women. [4],[5] The HSG test provides information regarding the morphology of the fallopian tubes, its patency and lesions in the uterine cavity and gives a clear picture of the previous pathologies and peritubal effection. [6],[7] The advantage of the HSG is that it is quick and easily available in most hospitals and it is believed that the primary role of HSG is in the assessment of tubal patency and it also plays a secondary role in the in assessment of uterine cavity with a sensitivity of 79% and a specificity of 82%. [8] The disadvantages are that it is sometime painful, emits radiation during the procedure and presents both false positive and negative findings. Despite these drawbacks, it remains one of the first tests to be performed in infertile patients. The objective of this retrospective study is to identify the results of HSG conducted on infertile Saudi Arabian women, particularly in relation to tubal and uterine pathology.


  Patients and Methods Top


This cross-sectional study was conducted on 117 Saudi Arabian women, who had been classified as infertile or subfertile and who had undergone HSG between June 2007 and May 2012. The women were aged between 21 and 43 years (average 32.59 ± 5.48 years). The patients' demographic data, including age, years of marriage, menstrual history, primary/secondary infertility, hormonal profile, previous infection or pelvic surgery, and diagnostic laparoscopy, were collected from the medical charts. Radiographic reports of HSG were collected from the picture archiving and communication system and analyzed for fimbrial findings, tubal patency, and cervical and uterine cavitary pathology. The data were entered in the database and analyzed using a t-test to compare means between age, type of infertility, different pathologies, and all the other parameters assessed. All tests were performed using Statistical Package for the Social Sciences, version 14.0, Chicago, Illinois, USA. A P < 0.05 was considered statistically significant with a confidence interval of 95%.


  Results Top


The data of 117 female patients aged between 21 and 43 years (average 32.59 ± 5.48 years), with a mean age of married life of 8.1 ± 4.86 (2-22) are shown in [Table 1]. Of the 117 women included in the study, 47 (40.2%) had been diagnosed with primary infertility, with the remainder identified as having secondary infertility. In 73 (62.39%) patients, menstrual periods were noted as being regular and 68 (58.12%) patients had not been diagnosed as suffering from any disease. In 95 (81.2%) patients, an abnormality in the fallopian tubes was detected and in 27 (23%) patients, an abnormality in the uterus was detected. The data revealed that two patients had a combined uterine and fallopian tube abnormality.
Table 1: Demographic data of 117 patients

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[Table 2] gives the details of the HSG and describes the tubal and uterine pathologies. Comparison of the patients with primary infertility and secondary infertility revealed that those with primary infertility were significantly younger (29.7 ± 5.6 vs. 34.58 ± 4.75; P < 0.001). The tubal and uterine pathology was more common in women diagnosed with primary infertility than those with secondary infertility (P < 0.08 and 0.01) [Table 3].
Table 2: Hysterosalpingography findings in 117 patients

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Table 3: Comparison between the primary and secondary infertility patients

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  Discussion Top


Different modalities have been extensively used in patients for infertility investigations. One of the most common ones used is HSG, which is routinely used to check tubal patency and uterine cavity abnormalities which are frequently reported in cases of infertility. More specifically, HSG provides ample information on the morphology on the fallopian tubes, its patency and lesions in the uterine cavity and gives a better picture of any previous pathologies and peritubal effection. However, recently, hysteroscopy (HS) which can directly visualize the uterine cavity has been compared to traditional HSG. Studies suggest that women who get a normal report on HSG, up to 35% had abnormal hysteroscopic findings. Taskin et al. [9] recommended that HS should be used for patients who are older than 35 years with failed in vitro fertilization (IVF). HSG shows unconvincing diagnostic value for intracavitary and structural uterine pathologies in infertility evaluation.

More recent modalities include sonohysterogram (SHG), which is gaining the support of radiologists in the evaluation process of the uterus and the fallopian tubes. Many studies have demonstrated the superiority of SHG over HSG in the evaluation of the uterus prior to IVF, particularly in patients who sustained recurrent abortions. [10],[11],[12] Acholonu et al. [13] compared SHG and HSG and found a significant accuracy of SHG of 75.5% compared to 50.3% for HSG due to its sensitivity which leads to a greater predictive value and accuracy. However, SHG cannot determine whether there are any abnormalities in the fallopian tubes.

Recently, Ma et al. [14] suggested that magnetic resonance imaging (MRI) with HSG can better improve the diagnosis in the pathologies of the adnexa and uterus, but this approach is not frequently used due to the expense and availability of MRI.

Lim et al. recommended that in the 21 st century HSG has no place in the evaluation of infertility and subfertility patients. They also believed that HSG results in unnecessary radiation exposure. [15] Laparoscopy is now advocated in the diagnosis of patency of the fallopian tubes even after the confirmation of tubal pathology by HSG and SHG. This procedure is invasive, requires hospital admission, and general anesthesia. However, an advantage of laparoscopy is that it provides a visual of peritubal adhesions. [16]


  Conclusion Top


Using HSG, our data showed that the majority (58.9%) of infertile patients included in the study had secondary infertility rather than primary infertility, which is in line with other studies. [17],[18],[19] HSG also revealed that in 81.2% of patients, abnormalities were seen in the fallopian tubes and only 23% in the uterus. Our study confirms that HSG should remain the first-line diagnostic test in the assessment of tubal and uterine abnormalities which are the most common issues influencing the fertility process. [20],[21],[22] Although our study has the usual limitations of any retrospective analysis, it is the first of its kind in the Saudi Arabian infertile population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Reproductive Health Outlook. Infertility: Overview/lessons learned, 1997-2005. Available from: http://www.rho.org. [Last accessed on 2011 Nov 20].  Back to cited text no. 1
    
2.
Inhorn MC. Global infertility and the globalization of new reproductive technologies: Illustrations from Egypt. Soc Sci Med 2003;56:1837-51.  Back to cited text no. 2
    
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Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: A prospective, randomized study. Fertil Steril 2000;74:1029-34.  Back to cited text no. 4
    
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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;23:1401-21.  Back to cited text no. 5
    
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Simpson WL Jr, Beitia LG, Mester J. Hysterosalpingography: A reemerging study. Radiographics 2006;26:419-31.  Back to cited text no. 6
    
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Roma Dalfó A, Ubeda B, Ubeda A, Monzón M, Rotger R, Ramos R, et al. Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: A comparison with hysteroscopy. AJR Am J Roentgenol 2004;183:1405-9.  Back to cited text no. 7
    
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Guimarães Filho HA, Mattar R, Pires CR, Araujo Júnior E, Moron AF, Nardozza LM. Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses. Arch Gynecol Obstet 2006;274:284-8.  Back to cited text no. 8
    
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Taskin EA, Berker B, Ozmen B, Sönmezer M, Atabekoglu C. Comparison of hysterosalpingography and hysteroscopy in the evaluation of the uterine cavity in patients undergoing assisted reproductive techniques. Fertil Steril 2011;96:349-352.e2.  Back to cited text no. 9
    
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Zafarani F, Ahmadi F. Evaluation of intrauterine structural pathology by three-dimensional sonohysterography using an extended imaging method. Int J Fertil Steril 2013;7:1-6.  Back to cited text no. 10
    
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Omari EA, Varghese T, Kliewer MA. A novel saline infusion sonohysterography-based strain imaging approach for evaluation of uterine abnormalities in vivo: Preliminary results. J Ultrasound Med 2012;31:609-15.  Back to cited text no. 11
    
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Tur-Kaspa I, Gal M, Hartman M, Hartman J, Hartman A. A prospective evaluation of uterine abnormalities by saline infusion sonohysterography in 1,009 women with infertility or abnormal uterine bleeding. Fertil Steril 2006;86:1731-5.  Back to cited text no. 12
    
13.
Acholonu UC, Silberzweig J, Stein DE, Keltz M. Hysterosalpingography versus sonohysterography for intrauterine abnormalities. JSLS 2011;15:471-4.  Back to cited text no. 13
    
14.
Ma L, Wu G, Wang Y, Zhang Y, Wang J, Li L, et al. Fallopian tubal patency diagnosed by magnetic resonance hysterosalpingography. J Reprod Med 2012;57:435-40.  Back to cited text no. 14
    
15.
Lim CP, Hasafa Z, Bhattacharya S, Maheshwari A. Should a hysterosalpingogram be a first-line investigation to diagnose female tubal subfertility in the modern subfertility workup? Hum Reprod 2011;26:967-71.  Back to cited text no. 15
    
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Corson SL, Cheng A, Gutmann JN. Laparoscopy in the "normal" infertile patient: A question revisited. J Am Assoc Gynecol Laparosc 2000;7:317-24.  Back to cited text no. 16
    
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Ugwu EO, Onwuka CI, Okezie OA. Pattern and outcome of infertility in Enugu: The need to improve diagnostic facilities and approaches to management. Niger J Med 2012;21:180-4.  Back to cited text no. 17
    
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Esmaeilzadeh S, Delavar MA, Zeinalzadeh M, Mir MR. Epidemiology of infertility: A population-based study in Babol, Iran. Women Health 2012;52:744-54.  Back to cited text no. 18
    
19.
Bhattacharya S, Porter M, Amalraj E, Templeton A, Hamilton M, Lee AJ, et al. The epidemiology of infertility in the North East of Scotland. Hum Reprod 2009;24:3096-107.  Back to cited text no. 19
    
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Crosignani PG, Rubin BL. Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group. Hum Reprod 2000;15:723-32.  Back to cited text no. 20
[PUBMED]    
21.
National Collaborating Centre for Women′s and Children′s Health. Fertility: Assessment and Treatment for People with Fertility Problems 2009. London: RCOG Press; 2004. p. 236.  Back to cited text no. 21
    
22.
Lanzani C, Savasi V, Leone FP, Ratti M, Ferrazzi E. Two-dimensional HyCoSy with contrast tuned imaging technology and a second-generation contrast media for the assessment of tubal patency in an infertility program. Fertil Steril 2009;92:1158-61.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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[Pubmed] | [DOI]



 

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