DIAGNOSTIC ROLE OF HYSTEROSALPINGOGRAPHY IN DETECTING TUBAL AND UTERINE CAUSES OF SECONDARY INFERTILITY IN MULTIPAROUS WOMEN
Keywords:
Hysterosalpingography, secondary infertility, multiparous women, tubal blockage, hydrosalpinx, uterine abnormalities, peritubal adhesions.Abstract
Background: Secondary infertility is a common reproductive health problem that may result from acquired tubal and uterine abnormalities. Hysterosalpingography (HSG) provides simultaneous assessment of uterine cavity morphology and fallopian tube patency.
Objective: To determine the pattern of HSG findings in multiparous women with secondary infertility and assess the frequency of tubal and uterine abnormalities and their association with selected reproductive factors.
Methods: A cross-sectional observational study was conducted among 60 multiparous women aged 20–45 years with secondary infertility at the Radiology Departments of Services Hospital and Jinnah Hospital, Lahore. Participants were selected using non-probability consecutive sampling. Data were collected through a structured proforma, clinical interviews, and review of HSG reports. HSG was performed during the early proliferative phase using water-soluble contrast under fluoroscopic guidance. Data were analyzed using descriptive statistics and Fisher’s Exact test.
Results: The majority of participants were aged 30–34 years (43.3%), with a mean BMI of 25.68 ± 2.45 kg/m². Tubal patency was observed in 10.0%, unilateral blockage in 48.3%, and bilateral blockage in 41.7% of participants. Proximal blockage was the most frequent site of obstruction (33.3%). Unilateral hydrosalpinx was present in 51.7%, while moderate and mild peritubal adhesions each occurred in 36.7%. Fibroids were the most common uterine abnormality (28.3%), followed by polyps and irregular uterine cavity (18.3% each). Uterine factor and combined factor infertility were each identified in 36.7%, while tubal factor infertility accounted for 26.7%. Significant associations were found between tubal patency (p=0.016), peritubal adhesions (p=0.036), and uterine abnormality type (p=0.019) with final diagnosis. Site of tubal blockage (p=0.288) and hydrosalpinx (p=0.062) were not significantly associated with final diagnosis.
Conclusion: HSG is a valuable imaging modality for evaluating secondary infertility in multiparous women. It effectively demonstrates tubal obstruction, hydrosalpinx, peritubal adhesions, and uterine cavity abnormalities, providing important information for classification and further management of infertility.
