Comparative hysteroscopic profiles among women with primary and secondary infertility at Benjamin Mkapa hospital: a...

Infertility affects an estimated 48 million couples globally, with disproportionately high rates in sub-Saharan Africa. Intrauterine abnormalities are common but underdiagnosed causes of infertility, particularly in low-resource settings where advanced diagnostic tools such as hysteroscopy are underutilized. This study aimed to compare hysteroscopic findings between women with primary infertility and those with secondary infertility at Benjamin Mkapa Hospital, Tanzania.

A hospital-based cross-sectional study was conducted among women with infertility who underwent diagnostic hysteroscopy. Simple random sampling was used. Hysteroscopic findings were categorized via the European Society for Gynecological Endoscopy (ESGE) classification system. The data were analyzed via Stata version 18.

A total of 198 women with infertility 103 (52.02%) with primary infertility and 95 (47.98%) with secondary infertility were included. Abnormal hysteroscopic findings were more prevalent in women with secondary infertility 56 (58.95%) than in those with primary infertility 28 (27.18%). The number of intrauterine adhesions was notably greater in the secondary infertility group (13.7%) than in the primary infertility group 6 (5.8%), with more severe adhesions observed. Conversely, secondary infertility was observed more often in patients with endometrial polyps (11.6%) than primary infertility was.

Secondary infertility is associated to acquired intrauterine pathology, particularly adhesions, which are likely to result from infections or trauma. Routine diagnostic hysteroscopy should be integrated into infertility workups to increase diagnostic accuracy and guide appropriate treatment, especially in resource-limited settings.