Findings in Subfertile Women utilizing Hysteroslpingography Services at The Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

Background: Subfertility is an important condition with widespread socio-cultural implications. Its prevalence has been increasing with structural anomalies of the female genital tracts being one of the biggest contributors. HSG studies are quintessential in diagnosing these and so invaluable in radiological work up of subfertile females. Few studies that are radiologically based have been done in Kenya hence such patterns as seen on HSG are not well known at MTRH. Objective: To determine patterns of structural defects as seen on HSG and its association with demographic characteristics and subfertility sub types. Research design & Methodology: This was a cross-sectional study done in the Radiology and Imaging department of MTRH. The study population was subfertile females. A sample size of 141 subfertile females was determined using fishers formula. Consecutive sampling was done. Non consenting or females with contra indications to HSG were not included. Data was analyzed using STATA version 12. Fischer’s exact and chi-square tests to determine associations. Results: Median age was 31 (IQR: 23-40) years. Most respondents, 131(93%) were married. Majority, 125(88.6%) had minimum level of secondary education. Primary subfertility seen in 40(28%) while secondary subfertility in 101(72%). Participants with primary subfertility presented at a mean duration of 4 years. Older participants had longer subfertility duration. A minority, 8(6%) had previous pelvic surgery; this wasn’t statistically significant as an associated factor for subfertility (p 0.616). Contraceptives had been used by 78(52%), with no significance noted toward having utero-tubal defects (P=0.078). Normal uterine findings were seen in 122(87%). Filling defects were the commonest uterine abnormality. Tubal blockage was common, present unilaterally in 18% and bilaterally in 27%. No risk of increased tubal defects was seen in either primary or secondary subfertility over the other. Older age was linked to presence of uterine abnormalities. There was no significant associations between education level, employment and type of subfertility or between contraceptive use and previous pelvic infection with occurrence of utero-tubal defects. Conclusions. Most patients were married and literate. Secondary subfertility was the commonest type. Tumors were the commonest uterine pathology and distal tubal occlusion the commonest tubal defect. There is a positive relationship between age and development of uterine defects. Recommendations There’s need for similar but larger studies to help determine associations of these patterns with a view of establishing proper interventions.