{"paper_id":"a8f33d13-97c2-4604-85d9-c55ded988663","body_text":"Open Journal of Medical Imaging, 2023, 13, 107-113 \nhttps://www.scirp.org/journal/ojmi \nISSN Online: 2164-2796 \nISSN Print: 2164-2788 \n \nDOI: 10.4236/ojmi.2023.133011  Aug. 30, 2023 107 Open Journal of Medical Imaging \n \n \n \n \nUltrasound Causes of Female Infertility at the \nFertilia Medical Clinic in Bamako \nMamadou Dembele1,2*, Alassane Kouma1, Ilias Guindo1, Zoumana Cheick Berete3,  \nSouleymane Sanogo1, Mamadou N'diaye1, Brahima Doumbia1, Oncoumba Diarra1,  \nOusmane Traore1, Issa Cisse1, Aboubacar Sidiki N’ Diaye1, Badiougou Doucoure2,  \nYoussouf Yalcouye2, Adama Diaman Keita1, Siaka Sidibe1 \n1Radiology Department, Faculty of Medicine and Odonto-Stomatology of Bamako (FMOS), Bamako, Mali \n2Radiology Unit, Fertilia Medical Clinic, Bamako, Mali \n3Department of Education and Research in Public Health (DERSP), FMOS, Bamako, Mali \n \n \n \nAbstract \nAims:  Infertility is a major problem  in our current societies and the Fertilia \nmedical clinic in Bamako is a center for medical assistance in procreation \n(MAP) where there is an increasingly growing demand for ultrasound.  The \nobjective of our study was to investigate the ultrasound causes li kely to pre-\nvent the occurrence of pregnancy in a group of infertile and subfertile wo m-\nen. Subjects and Methods:  This was a 5-year cross-sectional and prospective \nstudy, between January 2017 and January 2022, which involved 250 women \nwishing to become pregn ant (infertile or subfertile), who came for pelvic u l-\ntrasound or follicular monitoring and who agreed to participate in our study. \nThe parameters used were ultrasound reports including uterine, ovarian and \ntubal pathologies. It should be noted that in some  cases no ultrasound cause \nof infertility was found. Data were entered and analyzed in SPSS. Results : 250 \nwomen were recruited into our. The average age was 32 years with extremes \nranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 \nyears old. 139 patients or 55.6% had secondary infertility against 44.4% pr i-\nmary infertility. 202 patients or 80.8% had at least one ultrasound lesion and \n48 patients or 19.2% had no significant ultrasound abnormality. The most \nrepresented ultrasound lesions  were of uterine origin with 72.20%, 23.7% \novarian lesions and 04% tubal lesions. Uterine lesions were dominated by \nmyomas, adenomyosis, endometrial polyps, uterine malformations and syn-\nechiae. As for ovarian lesions we noted cysts, polycystic ovary syndro me \n(PCOS), ovarian endometriosis, non -follicular ovaries and tubal ultrasound \nlesions showed unilateral or bilateral hydrosalpinx. Conclusion:  In our study, \nultrasound was an invaluable contribution to the diagnosis of the causes likely \nHow to cite this paper: Dembele, M ., \nKouma, A ., Guindo, I ., Berete, Z .C., Sano-\ngo, S., N’diaye, M., Doumbia, B., Diarra, O., \nTraore, O ., Cisse, I ., N’Diaye, A .S., Dou-\ncoure, B ., Yalcouye, Y ., Keita, A .D. and \nSidibe, S. (2023) Ultrasound Causes of \nFemale Infertility at the Fertilia Medical \nClinic in Bamako. Open Journal of Medical \nImaging, 13, 107-113. \nhttps://doi.org/10.4236/ojmi.2023.133011 \n \nReceived:  August 7, 2023 \nAccepted: August 27, 2023 \nPublished: August 30, 2023 \n \nCopyright © 2023 by author(s) and  \nScientific Research Publishing Inc. \nThis work is licensed under the Creative \nCommons Attribution International  \nLicense (CC BY 4.0). \nhttp://creativecommons.org/licenses/by/4.0/  \n  \nOpen Access\n\nM. Dembele et al. \n \n \nDOI: 10.4236/ojmi.2023.133011 108 Open Journal of Medical Imaging \n \nto explain subfertility and infertility in our respondents. She highlighted ut e-\nrine, ovarian and tubal lesions, some of which could be corrected and pre g-\nnancies ensued. \n \nKeywords \nUltrasound, Female Infertility, Myomas, Polycystic Ovaries, Hydrosalpinx \n \n1. Introduction \nAccording to the World Health Organization (WHO), infertility is defined as the \nabsence of conception after at least 12 months of normal, regular, complete and \nunprotected sexual intercourse [1]. It affects around 180 million people worl d-\nwide and around one in six couples face primary or secondary infertility  [1] [2]. \nThe rate of infertility varies from one country to another, ranging from 5 % to \n8% in developed countries and from 5.8% to 44.2% in developing countries [3]. \nThe woman is still considered the main culprit of marital infertility. Many \nwomen remain marginalized, even repudiated because of this confusion linked \nto ignorance of the etio-pathogenic data of marital infertility. It is a social drama \nexperienced mainly by women in the African environment who are the first to \nbe questioned [4]. The most effective imaging techniques in female infertility are \nendoscopy (hysteroscopy and laparoscopy) and MRI. Conventional imaging \nmethods such as hysterosalpingography (HSG), and transvaginal ultrasound \n(ETV) are classified as screening ex aminations [5]. But in black Africa, MRI is \nnot widely available and expensive. ETV and HSG remain the only feasible \nmeans of imaging during the exploration of fema le infertility. [6]. The aim of \nour study was to show the role of this accessible and available imaging tool in the \nassessment of female infertility in a low -income country like Mali. Few studies \nhave been carried out in our country on this subject, so our study will serve to \nshed light on many people on female infertility given the interest of the subject. \nInternationally many studies have been done on fem ale infertility but they are \nfull of some shortcomings that we have tried to fill in our study. \n2. Materials and Method \nThis was a 5 -year cross-sectional and prospective study, between January 2017 \nand January 2022, which involved 250 women wishing to become pregnant (i n-\nfertile or subfertile), who came for pelvic ultrasound or follicular monitoring \nand who agreed to participate in our study. We gave ourselves a study duration \nof 5 years and all the patients who presented for ultrasound in a context of p ri-\nmary or secondary infertility at the time of our study and who agreed to partic i-\npate in our study constituted the size of our sample, \ni.e. 250 patients. The par a-\nmeters used were ultrasound reports including uterine, ovarian and tubal p a-\nthologies. It should be noted that in some cases no ultrasound cause of infertility \n\nM. Dembele et al. \n \n \nDOI: 10.4236/ojmi.2023.133011 109 Open Journal of Medical Imaging \n \nwas found. Data were entered and analyzed in SPSS. \n2.1. Exploration Techniques \nWe used different types of ultrasound machines such as Voluson E8, Logic9 and \nVivid3. The pelvic ultrasound was done in 95% of cases by the endovaginal route \nand generally on the second day of menstruation for cases of medically assisted \nprocreation and randomly for other cases. \n2.2. Data Processing and Analysis \nThe data collected on the technical sheets were enter ed and analyzed using SPSS \nsoftware. Spearman’s and Pearson’s correlation tests were used to determine the \ndegree of significance during comparisons at the 5% level. \n3. Results \n250 women were recruited into our study. The average age was 32 years with ex-\ntremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and \n35 years old. 139 patients or 55.6% had secondary infertility against 44. 4% pri-\nmary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 \npatients or 19.2%  had no significant ultrasound abnormality.  (Table 1 ) The \nmost represented ultrasound lesions were of uterine origin with 72.20%, 23.7% \novarian lesions and 04% tubal lesions. (Table 2) Uterine lesions were dominated \nby myomas, adenomyosis, endometrial polyps, uterine malformations and sy n-\nechiae. (Table 3) As for ovarian lesions we noted cysts, polycystic ovary sy n-\ndrome (PCOS), ovarian endometriosis, non -follicular ovaries and tubal ultr a-\nsound lesions showed unilateral or bilateral hydrosalpinx. (Table 4) \n202 patients or 80.8% had at least one ultrasound lesion and 48 patients or \n19.2% had no significant ultrasound abnormality. \nUterine ultrasound lesions dominated with 72.20% of cases. \n \nTable 1 . Distribution of patients according to the presence of echographic anomaly. \nUltrasound Lesions  Number  Percentage (%) \nYES 202 80.80 \nNO 48 19.20 \nTOTAL  250 100% \n \nTable 2 . Distribution of patients according to the origin of the ultrasound lesion. \nULTRASOUND LESION LOCALISATION  NUMBER  PERCENTAGE (%)  \nUTERINE 146 72.20 \nOVARIAN 48 23.70 \nTUBAL 8 4 \nTOTAL  202 100% \n\nM. Dembele et al. \n \n \nDOI: 10.4236/ojmi.2023.133011 110 Open Journal of Medical Imaging \n \nTable 3 . Distribution of patients by type of uterine abnormality. \nUltrasound Abdbnormality  Number  Percentage (%)  \nSINGLE MYOMA 28 19.17 \nMULTIPLE MYOMAS 85 58.21 \nADENOMYOSIS 26 17.80 \nENDOMETRIAL POLYP 5 3.42 \nUTERINE MALFORMATION 1 0.68 \nSYNECHIA 1 0.68 \nTOTAL  146 100% \n \nTable 4 . Distribution of patients by type of ovarian anomaly. \nUltrasound Abnormality  Number  Percentage (%)  \nSINGLE FUNCTIONAL CYST 8 16.66 \nBILATERAL FUNTIONAL CYST 5 10.41 \nPOLYCYSTIC OVARIAN SYNDROME  29 60.41  \nORGANIC CYST 1 02.08 \nOVARIAN ENDOMETRIOSIS 3 06.25 \nNON-FOLLICULAR OVARIES 2 04.16 \nTOTAL  48 100% \n \nThe polymyomatous uterus was the most represented on the ultrasound, \n58.21%, and almost all of these myomas were submucosal. Uterine myomatosis \naccounted for more than 77% of all uterine lesions observed, followed by ad e-\nnomyosis. \nPolycystic ovary syndrome (PCOS) was the most represented ovarian ultra-\nsound anomaly with just over 60%. In some cases , there were more than twenty \nfollicles per ovary with cycle disorders, hirsutism and a deep voice, witness to a \nfairly pronounced androgenism. \nTubal abnormalities were hydrosalpinx, 8 patients or 04%. Of the 8 pat ients, 5 \nhad bilateral hydrosalpinx and 3 had unilateral hydrosalpinx. \n4. Discussion \n250 women were recruited into our study. The average age was 32 years with ex-\ntremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and \n35 years old. Th is result is similar to that of Tiemtore K. \net al. [7] who found \n63.64% of subfertile women in Ouagadougou in 2016. \n139 patients or 55.6% had secondary infertility against 44.4% primary infertil-\nity. This score is similar to that of Dembélé N.  [8] who in 2021 had found \n55.70% secondary infertility versus 44.30% primary infertility. \nIn our study, ultrasound found abnormalities in 80.8% of respondents. Several \n\nM. Dembele et al. \n \n \nDOI: 10.4236/ojmi.2023.133011 111 Open Journal of Medical Imaging \n \nauthors have reported similar figures  [9] [10] [11]. This could be explained by \nthe fact that ultrasound is the first-line examination in the infertility assessment. \n72.20% of ultrasound abnormalities were of uterine origin. This score is above \nthat of Shalev J.  [12] who found 50.3% uterine causes and different from that of \nTiemtore K. et al. [7] who found 67% lesions of rather ovarian origin. \nMyomas accounted for more than 77% of all causes of uterine origin. This \nfigure is very close to that found by Gandji et al. [13] who found 76.8% of causes \nof infertility linked to myomas, especially submucosal. \nPolycystic ovary syndrome (PCOS) is the most represented ovarian ultra-\nsound anomaly with 60.41%. Biao et al. [14] reported similar results in their s e-\nries in 2008 (61%). Many other authors have reported that the main etiology of \ninfertility is related to an ovulation abnor mality such as polycystic ovary sy n-\ndrome (PCOS). [15] [16] [17] [18]. (Figure 1 ) \nTubal lesions were represented by hydrosalpinxes. They were not very repre-\nsentative in our study (04%). Camus E et al. [19] reported 06% of cases of h y-\ndrosalpinx and determined its role in in vitro fertilization (IVF) failures and r e-\nduction in the rate of natural and induced pregnancies. (Figure 2 & Figure 3) \nLimits of the Study \nSince this is a prospective study, the frequency of  female infertility would be un-\nderestimated in Bamako but also the causal diagnosis as well made difficult b e-\ncause of meager means paraclinical exploration. \n \n \nFigure 1. (a) Pelvic ultrasound by vaginal route on the 3rd day of menstruation with more \nthan 16 follicles per ovary; (b) Polyfollicular ovary on the 8th day of stimulation: High risk \nof ovarian hyperstimulation. \n \n \nFigure 2. Functional ovarian cyst. \n\n\nM. Dembele et al. \n \n \nDOI: 10.4236/ojmi.2023.133011 112 Open Journal of Medical Imaging \n \n \nFigure 3. (a) Polymyomatous uterus with nuclei compressing the cavity line;  (b) Left hy-\ndrosalpinx. \n5. Conclusion \nUltrasound in the assessment of female infertility in our context has been really \ncontributory because it has made it possible to diagnose uterine pathologies mostly \nresolved by polymyomectomy, ovarian pathologies marked by dysovulation \ntreated by ovulation inducers and ovarian and finally tubal monitoring. \nConflicts of Interest \nThe authors declare no conflicts of interest regarding the publication of this p a-\nper. \nReferences \n[1] World Health Organization (WHO) (2020) Infertility. WHO, Geneva.  \nhttps://www.who.int/fr/news-room/fact-sheets/detail/infertility  \n[2] Le Goff, S., Lédée, N. and Bader, G. (2008) Obesity and Reproduction: Review of the \nLiterature. 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Gynécologie Obstétrique & Fertilité , 28, \n234-239. \n[19] Camus, E., Poncelet, C., Goffinet, F., Wainer, B., Merlet, F., Nisand, I. and Philippe, \nH.J. (1999) Pregnancy Rates after In-Vitro Fertilization in Cases of Tubal Infertility \nwith and without Hydrosalpinx: A Meta- Analysis of Published Comparative St u-\ndies. Human Reproduction, 14, 1243-1249.  \nhttps://doi.org/10.1093/humrep/14.5.1243","source_license":"CC0","license_restricted":false}