Hysterosalpingographic Pattern of Primary Sub-fertility and Secondary Sub-fertility in   Women of Reproductive Age

Objective: To evaluate the structural abnormalities of uterus and fallopian tubes in women diagnosed with primary and Secondary Sub-fertility using hysterosalpingogram. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul to Nov 2019. Methodology: This study investigated potential anatomical causes of primary and secondary subfertility in women of reproductive age. A total of 500 participants, referred from Gynecology and Obstetrics Departments, underwent hysterosalpingography during the pre-proliferative phase following comprehensive medical history assessment. Results: Out 500 women, 340(68.0%) had Primary Sub-fertility while 160(32%) had Secondary Sub-fertility. Mean age of presentation was 31.5±3.5 years. Bilateral free peritoneal spill was recorded in 340(68%) patients. Unilateral tubal blockage was present in 50(10%) patients while bilateral tubal blockage was observed in 40(8.0%) patients. Bilateral hydrosalpinx was present in 15(3 %) women. Patients with uterine congenital anomalies were also examined, and bicornuate uterus was seen in 25(5%) women and unicornuate uterus was noted in the same number, that is, 25(5%) women. Conclusion: Hysterosalpingography is a baseline assessment test done for evaluation of patency of uterus and uterine tubes. Positive hysterosalpingography cases were more prevalent in Secondary Sub-fertility. Tubal abnormalities were more commonly observed as compared to uterine cavity pathologies. Secondary Sub-fertility was found to be more associated with older age groups.