Patterns of transvaginal ultrasound findings and its relationship with subfertility types in subfertile women at Moi Teaching and Referral Hospital

Abstract

Background: Subfertility is defined as failure to attain pregnancy after one year of regular, unprotected intercourse. Subfertility affects about 10-15% of couples. The exact magnitude and importance of subfertility as a public health problem in Africa is poorly understood. Prevalence of primary subfertility is reported as <5%, whereas secondary subfertility is common, ranging from 10-30% depending on the sociocultural settings. In Africa, most studies cover prevalence, while few studies have looked at the radiological point of view, especially possible structural causes of subfertility as evidenced on transvaginal ultrasonography (TVUS). Objectives: To determine patterns of transvaginal ultrasonographic findings and their relationship with subfertility subtypes as seen at MTRH. Methods: A cross-sectional study conducted at Moi Teaching and Referral Hospital (MTRH) in Eldoret for one year. Sample size was calculated using Fischer‟s formula and 100 female patients with clinical subfertility and referred for ultrasound were recruited after obtaining consent. Endocavitary vaginal probe of Mindray M7 machine was used to scan the patients. Consecutive sampling technique was used to recruit patients with subfertility. Continuous variables were summarized as means and standard deviations. Categorical variables were summarized in frequency, percentages and tables. Fisher's exact test was used to assess the association between subfertility types and transvaginal ultrasound patterns. Results: The mean age of the recruited women included in the study was 35.3 years. Of the 100 patients, 80 had primary subfertility while 20 had secondary subfertility. On the patterns of transvaginal ultrasonographic findings, 40 (40.0%) had normal ultrasound findings, 14 (14.0%) had leiomyoma, 13 (13.0%) polycystic ovaries, 8 (8.0%) Pouch of Douglas (POD) free fluid noted, 6 (6.0%) functional ovarian cysts, 6 (6.0%) adenomyosis, 5 (5.0%) hydro-salpinx, 3 (3.0%) congenital malformations, 3 (3.0%) Endometrioma, 1 had Tubo-ovarian mass and 1 Hydro-salpinx with functional ovarian cyst. Regarding the association between the ultrasound findings and the subfertility types, no statistically significant association, P-values of >0.005(Fischer's exact test), was found between the TVUS findings and subfertility types. Conclusion: Women subfertility in this study is associated with multiple structural abnormalities involving the uterus, ovaries, fallopian tubes. TVUS is a useful diagnostic modality for evaluating abnormalities. Leiomyoma and PCOS are the leading causes of subfertility. The proportion of primary subfertility is high (80%) in this study. Recommendations:Well-designed large cohort or randomized studies are needed to understand the association between subfertility types and ultrasound findings in patients with subfertility.