DIAGNOSTIC YIELD OF HYSTEROSCOPIC EVALUATION OF INFERTILITY IN PORT HARCOURT, NIGERIA

Infertility remains a significant public health burden in Nigeria and the developing world. Uterine factors are known to contribute significantly to pregnancy outcomes. Hysteroscopy is regarded as the Gold Standard for diagnosing and treating uterine factor infertility. The current consensus is for the application of diagnostic hysteroscopy to patients with a history of previous implantation failure following assisted conception. Some studies have shown improved pregnancy rates and live birth rates after addressing uterine factors prior to the first assisted conception. With the high burden of infertility, rising cost of assisted conception, increasing availability of hysteroscopic services with the attendant good safety profile, the need for routine diagnostic hysteroscopy as part of the infertility workup even before assisted conception is considered has been advocated. There is paucity of data to arrive at a consensus on this in our environment. Most of the available studies were conducted in Europe. This was a 3 year retrospective study between January 2022 and December 2024 conducted on participants who had routine diagnostic hysteroscopy in the gynaecology unit of a private health facility in Port Harcourt, Nigeria. A total of 83 diagnostic hysteroscopy procedures were performed during the period of which the 59 who were for routine infertility evaluation, were recruited. The mean age of the women was 37.1 years with majority (64.4%) aged between 30 and 39 years. The modal parity was para O (61%). Of the 59, 21 had normal hysteroscopic findings while 16 had intrauterine adhesions, 12 had uterine polyps, 5 had sub-mucous fibroids and 5 had stenosed internal cervical os as single or multiple pathologies seen at hysteroscopy giving a diagnostic yield of 64.4%. With the high burden of infertility in Nigeria and the developing world, the very high cost of assisted conception, the increasing availability and safety of diagnostic hysteroscopy, the finding of a high diagnostic yield at routine diagnostic hysteroscopy and evidence suggesting improved pregnancy outcomes following hysteroscopic treatment of uterine factor infertility, a case can be made for routine hysteroscopic evaluation of all infertility cases.