Abayomi Ajayi1, Oluwafunmilola Biobaku1, Victor Ajayi1, Ifeoluwa Oyetunji1, Happiness Aikhuele1 and Bamgboye M Afolabi2
Abstract
Background: Hysteroscopy is an essential tool of choice to make intrauterine abnormalities (IUA) visible and to allow for appropriate and adequate corrections. IUA are considered to be detrimental to the chances of conception after in-vitro fertilization. Objective: To determine the frequency and pattern of IUA identified at hysteroscopy among infertile women (IW) attending Nordica Fertility Centre (NFC) in Lagos, Nigeria.
Methods: This is a retrospective study of 1115 consecutive IW that underwent diagnostic or therapeutic hysteroscopy at the endoscopy arm of NFC between June 2005 and November 2014. Age (years) was categorized into <30, 30-34, 35- 39, 40-44, 45-49 and ≥50 and Body Mass Index (BMI kg/m2) into underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), obese (≥30.0). Analysis was done using STATA 13 and the level of significance was set at P<0.05.
Results: The means (± SD) of age (years), BMI (Kg/m2) and duration of infertility were 39.0 (6.1), 27.7 (4.8) and 7.5 (5.5) respectively. Three hundred and nineteen (28.6%) and seven hundred and ninety-five (71.4%) presented with primary and secondary infertility respectively. In all, 681 (61.1%) IW had abnormal hysteroscopic findings consisting of intra-uterine adhesion [IUA] (338, 30.3%), sub-mucous fibroid (173,15.5%), endometrial polyps (146,13.1%), endocervical adhesions (36,3.2%), intra-uterine septum (26,2.3%), endocervical polyps (14,1.3%) and endometritis
(2, 0.2%). The prevalence of sub-mucous fibroid (84, 48.6%) and IUA (168,49.7%) were higher among overweight IW
Conclusion: Our data are an additional argument to propose prior intra-uterine evaluation by hysteroscopy before In-vitro fertilization. Our study therefore recommends routine hysteroscopy prior to in-vitro fertilization process.
Keywords: Hysteroscopy, Infertility, Intra-uterine adhesions, Fibroids, Nigeria
Abbreviations: AUB: Abnormal uterine bleeding, BMI: Body Mass Index, CS: Caesarian section, D&C: Dilatation and curettage, WCBA: Women in child-bearing age, SSA: Sub-Saharan Africa, HSG: Hysterosalpingogram, IUA: Intra uterine adhesions, NFC: Nordica Fertility Center, IVF: In-vitro fertilization, WHO: World health Organization