Female infertility

Female infertility is common and can be due to a number of factors. Radiology often plays a key part in the work-up.

Pathology

Etiology

Often more than one factor (including male infertility) is the cause of infertility, some of the common significant risk factors for infertility are listed below

• age > 35 years
• immunological, e.g. antisperm antibodies
• Fallopian tube abnormalities (30-40%), e.g. tubal occlusion, salpingitis isthmica nodosa, peritubal adhesions
• endometriosis
• uterine abnormalities
  • intrauterine, e.g. Asherman syndrome, submucosal uterine fibroids, endometrial polyps
  • uterine body, e.g. adenomyosis, Müllerian duct anomalies
• cervical abnormalities, e.g. cervical factor infertility, cervical stenosis
• ovarian abnormalities, e.g. premature ovarian failure, polycystic ovarian syndrome, ovarian agenesis

Radiographic features 

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