(EFFECT OF HYSTEROSALPINGOGRAPHY
IN THE DIAGNOSE OF INFERTILITY IN WOMEN)
CHAPTER 1
INTRODUCTION
1.1
Background to the Study
The World
Health Organization (WHO) defines infertility as “a disease of the reproductive
system defined by the failure to achieve a clinical pregnancy after 12 months
or more of regular unprotected sexual intercourse” (World Health Organization,
2009).
In most parts
of the world, infertile couples, especially the women suffer physical and
mental abuses, neglect, economic deprivation and social ostracism (Onufus,
Harries, Odebiyi, Kare & Snow, 1997). Detecting the cause of infertility
and its successful management to achieve the desired result (pregnancy), brings
much joy to couples and families and has been shown to strengthen marriages
(Tara & Domar, 2007).
Despite the
availability of an array of diagnostic modalities such as Ultrasound (US),
Magnetic Resonance Imaging (MRI), Hysteroscopy and Laparoscopy,
Hysterosalpingography (HSG) is still a very valuable tool in the work-up of
women with infertility. 80 – 93% of these women show one form of abnormality or
another on HSG (Ubeda, Paraiza, Alert &
Abuin, 2010). It is still a first line
investigation in the evaluation of tubal patency (Lim, Hasata, Bhacharya &
Maheshwari, 2011). Other diagnostic modalities are either not readily available
in most of our local centres, or they may be less insensitive, with reduced
resolution and definition especially in detecting tubal abnormalities which
many studies have shown to contribute between 30 – 40% to the problem of infertility
in women (Dalfo, Ubeda, Ubeda & Monzon, 2004). HSG’s sensitivity and
specificity are estimated at 65 – 81% and 47 – 50% respectively for tubal pathologies
(Sakar, Gul, Ateng & Celi, 2008).
Hysterosalpingography (HSG),
also known as uterosalpingography,
(RadiologyInfo, 2016) is a radiologic procedure to investigate the
shape of the uterine cavity and the shape and patency of the fallopian
tubes. This means it is a special x-ray using dye to look at the womb (uterus)
and Fallopian tubes (MedlinePlus Medical Encyclopedia, 2019). It
injects a radio-opaque material into the cervical canal and
usually fluoroscopy with image intensification. A normal result shows
the filling of the uterine cavity and the bilateral filling of the fallopian tube
with the injection material. To demonstrate tubal rupture, spillage of the
material into the peritoneal cavity needs to be observed. It has
vital role in treatment of infertility especially in case of fallopian tube
blockade.
Hysterosalpingography (HSG) is an X-ray
procedure that is used to view the inside of the uterus and fallopian tubes.
It often is used to see if the fallopian tubes are partly or fully blocked. It
also can show if the inside of the uterus is of a normal size and shape. All of
these problems can lead to infertility and pregnancy
problems.
Evaluation for infertility and
congenital uterine malformations are among the common reasons for ordering an
HSG examination (Heasler & Brant, 2008).
An x-ray (radiograph) is a noninvasive
medical test that helps physicians diagnose and treat medical conditions.
Imaging with x-rays involves exposing a part of the body to a small dose of
ionizing radiation to produce pictures of the internal structures of the human
body.
Normally, soft, hollow structures such
as the womb (uterus) are difficult to see on X-ray images. In
Hysterosalpingography a dye that blocks X-rays is inserted into the uterus and
ovarian tubes. This dye is called a contrast agent or contrast medium. This
helps to produce useful pictures. By blocking the X-rays, contrast dye makes
the structures being examined bright white in colour. This helps to show the
important areas (uterus and fallopian tubes), by making them stand out against
the black background of the X-ray. Radiological assessment of uterus can help
determine whether the fallopian tubes are open or blocked and whether the
blockage is located at the junction of the tube and the uterus (proximal) or it
is at the end of the fallopian tube (distal).
According to The World Health
Organization (2009), infertility is defined as: “a disease of the reproductive
system defined by the failure to achieve a clinical pregnancy after 12 months
or more of regular unprotected sexual intercourse.”
Different factors are attributed to
infertility including male factor, ovulation problems and uterine and tubal
pathologies (Brown et al., 2007;
Farhi & Ben-Haroush, 2011).
Tubal causes are attributed to both
primary and secondary infertility with higher prevalence in secondary type,
making routine tubal evaluation in secondary infertility a recommendation (Lash
et al., 2008; Bello et al., 2006). Uterine causes of infertility include polyps
or fibroids, uterine wall irregularities and congenital anomalies.
1.2
Statement of the Problem
Hysterosalpingography (HSG)
is considered a very safe procedure. However, there is a set of recognized
complications, some serious, which occur less than 1% of the time. The most
common serious problem with HSG is pelvic infection. This usually occurs when a
woman has had previous tubal disease (such as a past infection of chlamydia).
In rare cases, infection can damage the fallopian tubes or make it necessary to
remove them. A woman should call her doctor if she experiences increasing pain
or a fever within 1-2 days of the HSG. Rarely, the woman may get light-headed
during or shortly after the procedure.
Radiation
exposure from an HSG is very low, less than with a kidney or bowel study. This
exposure has not been shown to cause harm, even if a woman conceives later the
same month. The HSG should not be done if pregnancy is suspected. Rarely,
a woman may have an allergy to the iodine contrast used in HSG. Women who are
allergic to iodine should have the HSG procedure performed without an
iodine-containing contrast solution. If a woman experiences a rash, itching, or
swelling after the procedure, she should contact her doctor. Spotting sometimes
occurs for 1-2 days after HSG. Unless instructed otherwise, a woman should notify
her doctor if she experiences heavy bleeding after HSG.
1.3 Aim/Objectives of
the Study
The
aim of this study is to assess the effect of Hysterosalpingography (HSG) in the
diagnose of infertility in women. The study shall also cover the following objectives:
1. To evaluate the pathological conditions
associated with the female reproductive system.
2. To
evaluate the importance of Hysterosalpingography (HSG) in the diagnose of
infertility in women.
3.
To determine the equipment
used in hysterosalpingography (HSG).
4.
To determine the benefits and risk of
Hysterosalpingography (HSG).
5.
To determine the procedure and
preparation for Hysterosalpingography (HSG).
1.4 Research Questions
1. What are the pathological conditions associated
with the female reproductive system?
2. What
are the importance of Hysterosalpingography (HSG) in the diagnose of
infertility in women?
3. What are
the equipments used in hysterosalpingography (HSG)?
4. What
are the benefits and risk of Hysterosalpingography (HSG)?
5. What
are the procedures and preparations for Hysterosalpingography (HSG)?
1.5 Significance of the
Study
The
importance of this research cannot be over emphasized. The finding from this
study will help women to know about the importance of
Hysterosalpingography in the diagnose of infertility.
It will also
enable couples and physicians (Radiologist) to ascertain the precise reasons
why a woman could not be pregnant, without an incision.
The
findings from this study can also serve as referral material.
1.6 Scope of the Study
The
study shall cover the following areas:
i.
Hysterosalpingography
ii.
Infertility
iii.
Women
iv.
Radiology
1.7 Limitation of the Study
In the
process of running this research work the attitude of clinical respondents to
vital information serves as a major constraint and also finances and time as
well were considered to be common restricted means to carry out this project
work.
1.8 Operational Definition of Terms
Importance: The quality of something being significant, valued,
or necessary in a particular situation.
Hysterosalpingography: Hysterosalpingography (HSG) also known as
uterosalpingography is a radiological procedure that helps evaluate and
investigates the morphology of uterine cavity and the patency of fallopian
tubes and is a widely used radiological procedure that uses a special form of x
ray called fluoroscopy and a contrast medium called "urographin".
Diagnose: to
recognize and name the exact character of a disease or a problem, by examining
it.
Infertility: Diminished
or absent ability to conceive and bear offspring.
Women: an
adult female human being
Radiology: is a branch of medicine concerned with the use
of radiant energy (as X-rays) or radioactive material in the diagnosis and
treatment of disease
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