Comparative Analysis of Hysteroscopic Findings among infertile Women in Nigeria and in India: a Preliminary Investigation

Background: Hysteroscopy is considered the gold standard in assessing the uterine cavity for pathology. Uterine factors contribute significantly to etiology and treatment of infertility. Objectives: To compare hysteroscopic findings among infertile Nigerian women and their Indian counterparts, determine if there are any differences and attempt to explain why the differences exist. Methods: A retrospective study conducted at Nordica Fertility and Endoscopy Centre, Lagos, Nigeria and Dr. Ramesh Gynae, Endoscopy and Infertility Centre, Bangalore, India. The biodata and findings at hysteroscopy of 100 consecutive infertile Nigerian women who had hysteroscopy between January and December 2010 and 111 consecutive infertile women who also had hysteroscopy at about the same time at Bangalore, India were reviewed and compared. Analysis was done using SPSS version 17.0. Results: There was a significant difference (t=10.7, P-value=0.00001) in the mean (±sd) age (years) of the Nigerian women at 39.3 (5.8) compared to 30.7 (5.9) among Indian women. Primary infertility (73.0%) was a common finding among Indian women while secondary infertility (66.0%) was more prevalent among Nigerian women who were over five times more likely to have this condition compared to Indian women (χ2=32.2, P-value=0.0001, OR=5.2, 95% CI: 2.9, 9.4). In all, 30 (27.0%) and 78 (78.0%) of Indian and Nigerian women respectively had abnormal hysteroscopic results. Nigerian women were about 10 times more likely to have an abnormal hysteroscopic outcome compared to Indian women (χ2=54.7, P-value=0.0001, OR=9.6, 95% CI: 5.09, 18.01). Intrauterine adhesion (44.9% vs 13.3%) and sub-mucous fibroids (21.8% vs 6.7%) were more pronounced among Nigerians while polyps (30.0% vs 24.4%) and complete septum (6.7% vs 5.1%) were more common among Indians who had abnormal hysteroscopic findings. Indian women were 1.3 times more likely to present with polyps (χ2=0.36, P-value=0.55, OR=1.33, 95% CI: 0.52, 3.40) and 1.32 times more likely to present with complete septum (χ2=0.02, P-value=0.75, OR=1.32, 95% CI: .23, 7.62) than Nigerian women. Conclusion: Sub-mucous fibroid and intra-uterine adhesion were more pronounced among Nigerians while polyps and complete septum were more common among Indian women.