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.