Transvaginal ultrasound in the evaluation of female infertility: spectrum of sonographic findings in a hospital-based cross-sectional study from Eastern Nepal

Infertility is a major global reproductive health issue that carries significant sociocultural stigma and psychological distress, especially among women in South Asia, including Nepal. Transvaginal ultrasound (TVUS) is a safe, accessible, and cost-effective first-line imaging tool for evaluating structural causes of infertility in low- and middle-income countries (LMICs). This study aimed to determine the prevalence and spectrum of pelvic sonographic abnormalities detected by TVUS among women with infertility at a tertiary care hospital in Eastern Nepal. This hospital-based, prospective cross-sectional study was conducted at Nobel Medical College Teaching Hospital, Biratnagar, Nepal, from May 2025 to May 2026. A consecutive sample of 200 women with primary or secondary infertility was enrolled. Standardized TVUS examinations were performed by a single experienced radiologist using a 5–9 MHz endovaginal probe. Demographic data, infertility type, and sonographic findings were recorded and analyzed using descriptive statistics and the Chi-square (χ²) test in IBM SPSS version 27. The mean age of participants was 31.4 ± 5.8 years. Primary infertility was present in 71.0% ( n = 142) and secondary infertility in 29.0% ( n = 58). TVUS detected pelvic sonographic abnormalities in 60.0% ( n = 120) of women, while 40.0% ( n = 80) had normal pelvic findings. Among assigned primary sonographic diagnoses, submucous fibroids were most common (13.0%, n = 26), followed by bulky uterus, polycystic ovarian morphology (PCOM), and adnexal cysts (each 10.0%, n = 20). Adenomyosis, endometrial polyps, and congenital uterine anomalies accounted for 6.5%, 5.5%, and 5.0% of participants, respectively. No statistically significant associations were found between pelvic abnormalities and infertility type (χ² = 1.04, p = 0.31) or age group (χ² = 7.44, p = 0.114). TVUS identified pelvic sonographic abnormalities in 60% of women with infertility at a tertiary care hospital in Eastern Nepal. These findings support its routine use as a first-line imaging modality within a comprehensive infertility evaluation.