Female infertility is common and can be due to a number of factors. Radiology often plays a key part in the work-up.
- age > 35 years
- immunological, e.g. antisperm antibodies
- Fallopian tube abnormalities (30-40%), e.g. tubal occlusion, salpingitis isthmica nodosa, peritubal adhesions
- uterine abnormalities
- cervical abnormalities, e.g. cervical factor infertility, cervical stenosis
- ovarian abnormalities, e.g. premature ovarian failure, polycystic ovarian syndrome, ovarian agenesis
Multiple imaging modalities are available to investigate the causes of infertility. Initial investigation with hysterosalpingography is helpful in either identifying a specific cause, or demonstrating features that can direct the appropriate use of other imaging modalities.
Fallopian tube pathology accounts for the majority of cases of infertility. It follows that hysterosalpingography is an appropriate initial imaging investigation because it is particularly good in demonstrating tubal patency, occlusion, irregularity, and peritubal disease.
Further imaging modalities that can be employed:
- pelvic ultrasound: evaluating uterine contour abnormality, or as a second step when hysterosalpingography is normal
- hysterographic ultrasound: evaluating intrauterine filling defects on hysterosalpingography, where causes can include endometrial polyps, submucosal fibroid, and intrauterine adhesions
- pelvic MRI: evaluating peritubal and uterine contour abnormalities
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- 3. Berry. Diagnostic Radiology. Jaypee Brothers Medical Publishers (P) Ltd. ISBN:8180610454. Read it at Google Books - Find it at Amazon