Pattern and Distribution of Pelvic Pathologies Detected by Transvaginal Sonography and Laparoscopy among Subfertile Women in a Tertiary Care Hospital

Open Access

Abstract

Background: Subfertility affects 10-15% of couples, and pelvic diseases are key etiological factors in women. Transvaginal sonography (TVS) is used as first-line imaging, with laparoscopy remaining the gold standard for thorough pelvic examination. This study aimed to assess the pattern and distribution of pelvic diseases found by TVS and laparoscopy in subfertile women, as well as the diagnostic association between these modalities. Methods & Materials: This cross-sectional study was carried out at BIRDEM General Hospital in Dhaka from January 2023 to June 2024. 66 subfertile women had TVS on day 9 of their menstrual cycle, followed by diagnostic laparoscopy with chromopertubation in the post-menstrual phase. Data were entered and analyzed using SPSS version 26, with Fisher's exact test measuring correlation between findings (p<0.05). Results: The mean age was 29.1±3.9 years, the mean duration of subfertility was 4.48±3.3 years, and 69.7% had primary subfertility. 60.6% of individuals had irregular menstrual periods. The most prevalent conditions were PCOS (53.1% on TVS and 56.1% on laparoscopy), ovarian cysts (18.2% vs. 15.2%), and endometriosis (13.6% vs. 12.1%). Only laparoscopy revealed peritubal adhesions (4.5%) in laparoscopy only. Normal results were uncommon (3.1% on laparoscopy, 10.6% on TVS). For individual disorders, there were no statistically significant changes between modalities (p>0.05). TVS-detected diseases were substantially predicted by irregular menstrual cycles (adjusted OR=3.21, p=0.048). Conclusion: Subfertile women have a high prevalence of pelvic disease, with the most common being polycystic ovarian syndrome, while peritubal adhesions were detected exclusively by laparoscopy. While TVS and laparoscopy have statistically similar results, laparoscopy is still required to detect peritoneal pathologies. A supplementary technique improves diagnostic accuracy in subfertility evaluation.