Abstract
Study question
What is the prevalence of abnormal findings on transvaginal ultrasound scan (TVS) in a population of women presenting with subfertility to a One-Stop fertility clinic?
Summary answer
Two thirds of women in our population had ultrasound-detected pathology. The five commonest pathologies were uterine fibroids, polycystic ovaries, endometriosis, adenomyosis and benign ovarian cysts.
What is known already
Gynaecological pathology is common in women presenting with subfertility. However, their prevalence varies depending on the age, geography, background health of the population and study design. Few prevalence studies performed in the general female population show definitive associations with subfertility. As imaging techniques become increasingly sophisticated and patient demographics evolve over time, the prevalence of gynaecological pathology is anticipated to change. Understanding their prevalence in a subfertile population would shed light on the burden of disease, providing information about prevention strategies and service priorities. There are no published studies on the prevalence of ultrasound-detected gynaecological pathology in the subfertile population.
Study design, size, duration
This was a retrospective cross-sectional study of 1558 women presenting to a One-Stop fertility clinic of a university teaching hospital between January 2012 and December 2020.
Participants/materials, setting, methods
Women who attend the clinic routinely have their demographic data and a detailed clinical history taken prior to a transvaginal ultrasound scan. A clinical examiner trained in transvaginal ultrasonography performs the ultrasound examination in a standardized fashion. Ultrasound features and diagnoses are systematically recorded in an electronic database. We obtained demographic data and details of gynaecological diagnoses from the electronic database. We analysed the data using descriptive statistics and reported our results as proportions.
Main results and the role of chance
The median age of women at the time of scan was 35 years (range 21–46 years). The mean Body Mass Index was 24.8 kg/m2 (range 16.9–50.4 kg/ m2). The median duration of subfertility was 24 months (range 3–168 months). 472/1558 (30.3%, 95% CI 28.0–32.6) women had normal pelvic scans. The most frequent pathology seen in our population was uterine fibroids (410/1558, 26.3%; CI 24.1–28.6); 10.5% of these fibroids distorted the uterine cavity. Polycystic ovaries were the next most common pathology (363/1558, 23.3%; CI 21.2–25.4), followed by endometriosis (177/1558, 11.4%; CI 9.8–13.0), adenomyosis (160/1558, 10.3%; CI 8.8–11.9) and benign ovarian cysts (122/1558, 7.8%; CI 6.6–9.3). The other abnormalities seen on scan included congenital uterine anomalies (81/1558, 5.2%; CI 4.2–6.4), endometrial polyps (69/1558, 4.4%; CI 3.5–5.6), pelvic adhesions (44/1558, 2.8%; CI 2.1–3.8) and intrauterine adhesions (13/1558, 0.8%; CI 0.5–1.4).
Of the 1086 women with abnormal scans, 832 (76.6%, CI 74.0–79.1) had one pathology detected on TVS and 254 (23.4%, CI 20.9–26.0) had more than one pathology detected.
Limitations, reasons for caution
A limitation of our study was the lack of histological confirmation of the ultrasound findings. Due to our smaller sample size, our prevalence could potentially be overestimated.
Wider implications of the findings: The relevance of each pathology to chances of conception requires further examination to avoid under- or overtreating women in their fertility journey. Our findings may provide a background for future correlation studies. Furthermore, a scan quality assessment may be considered if the detection rate is substantially different in similar populations.
Trial registration number
Not applicable
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