article · West African Journal of Allied Health Sciences
Infertility assessments in resource-limited regions can benefit from non-invasive imaging techniques to evaluate physical contributors to poor reproductive outcomes. In a study conducted in Maiduguri, Nigeria, researchers evaluated uterine artery blood flow and subendometrial perfusion in 300 infertile women alongside 300 fertile controls using transvaginal Doppler ultrasound during the mid-luteal phase. The results revealed that infertile women experienced significantly higher vascular resistance in the uterine arteries, marked by higher mean resistivity and pulsatility indices compared to the control group. Furthermore, subendometrial blood flow was substantially compromised, with only about half of the infertile participants demonstrating optimal perfusion patterns compared to all of the fertile controls. These findings indicate that reduced uterine perfusion is a prominent feature among infertile women in this setting, supporting the adoption of Doppler ultrasound within routine diagnostic workflows.
Infertility affects millions of couples, particularly within parts of Africa facing high prevalence rates. Identifying physiological factors such as poor blood flow to the uterus provides clearer explanations for impaired endometrial receptivity. Utilising accessible imaging tools like Doppler ultrasound allows clinicians to pinpoint these vascular issues, offering pathways to better diagnostics and targeted management strategies.
This research provides applied clinical evidence supporting the routine use of transvaginal Doppler ultrasound protocols in fertility clinics and diagnostic imaging centres within resource-limited environments. Because it relies on established ultrasound equipment rather than new proprietary devices, the primary translation pathway lies in clinical workflow integration and diagnostic standardisation to detect reversible perfusion deficits in infertile patients.
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Background: Objectives: This study aims to determine and compare uterine artery Doppler indices and subendometrial blood flow patterns between infertile and fertile parous women in Maiduguri, Nigeria, a region within Africa's high-prevalence infertility belt. Methods: This prospective case-control study was conducted over 13 months period involving 300 newly diagnosed cases of infertile women and 300 aged-matched fertile parous controls. Transvaginal Doppler ultrasound was performed during the mid-luteal phase. Uterine artery pulsatility index (PI) and resistivity index (RI) were measured, and subendometrial blood flow was classified into zones (1-4). Main Outcome Measures mean uterine artery Pulsatility Index, Resistivity Index, and distribution of subendometrial blood flow zones. Results: The mean age was 30.3±7.0 years for cases and 34.7±6.9 years for controls (p<0.001). Infertile women exhibited significantly higher uterine artery impedance: mean RI was 0.79±0.07 vs. 0.73±0.06 (p<0.001), and mean PI was 2.15±0.56 vs. 1.69±0.30 (p<0.001). Subendometrial perfusion was markedly reduced in the infertile group (p<0.001); while all controls (100%) displayed optimal Zone 3 flow, only 54.3% of infertile women did. Furthermore, 45% of infertile women had a clinically high RI (>0.8) compared to none in the control group. Conclusion: Infertile women in this population demonstrate significantly impaired uterine perfusion, evidenced by elevated Doppler indices and reduced subendometrial blood flow. These findings support the integration of Doppler ultrasound into the diagnostic work-up for infertility in similar resource-limited settings, as it identifies a potential, reversible contributor to poor endometrial receptivity.
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DOI: 10.67891/19dx3411
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