Hysterosalpingography in the Workup of Female Infertility: Spectrum of Diagnostic Findings in Uyo, Nigeria

Abstract

Background: Female infertility remains a significant reproductive health concern in sub-Saharan Africa, with tubal and uterine pathologies accounting for a substantial proportion of cases. Hysterosalpingography (HSG) continues to play a pivotal role in the initial radiological assessment of infertility, particularly in resource-limited settings where advanced imaging modalities may not be readily available. Aims: This study aimed to evaluate the indications for HSG and analyse the spectrum of diagnostic findings obtained during HSG examinations performed in the investigation of female infertility at a private radiodiagnostic centre in southern Nigeria, thereby providing evidence to inform appropriate clinical management. Methodology: A retrospective descriptive study was conducted using HSG examinations performed for infertility evaluation between January 2020 and December 2024. Patients’ demographic data, procedural indications, radiographic techniques, and findings were extracted from the Vitrea system and hospital records. Data were analysed using descriptive statistics. Results: A total of 312 women were included, with a mean age of 32.8 ± 5.4 years. The predominant indication was secondary infertility (71.8%), followed by primary infertility (28.2%). Abnormal HSG findings were observed in 72.4% (n = 226) of cases. Tubal abnormalities were the most frequent findings (50.6%), comprising unilateral tubal blockage (18.6%), bilateral tubal blockage (27.2%), and hydrosalpinx (3.8%). Uterine abnormalities were identified in 28.5% of patients and included fibroids, intrauterine adhesions, and congenital anomalies. Conclusion: Hysterosalpingography remains a valuable, cost-effective, and accessible tool in the diagnostic work-up of female infertility in Nigeria. Tubal abnormalities constituted the majority of detected abnormalities, underscoring the importance of early radiological evaluation in guiding appropriate management.