Prevalence of Congenital Uterine Anomalies among Infertile Women in Al-Jabal Al-Akhdar, Libya: A Cross-Sectional Study of Demographic Characteristics and Diagnostic Findings

Congenital uterine anomalies (CUA) are Müllerian duct defects linked to impaired fertility and adverse obstetric outcomes, yet North African prevalence data are scarce. The objective of this study is to determine the prevalence and spectrum of CUA among infertile women at a specialized center in eastern Libya, and to assess agreement between transvaginal ultrasonography (TVS), laparoscopy, and hysteroscopy. In this cross-sectional review of 165 infertile women, age, body mass index (BMI), infertility type, and findings at TVS, laparoscopy, and hysteroscopy were abstracted. CUA was defined by a two- cavity uterus on TVS, a bicornuate uterus at laparoscopy, or a septum, T-shaped cavity, or bicornuate configuration at hysteroscopy. Prevalence was reported with a 95% confidence interval (CI); the chi-square, fisher exact, and Mann-Whitney U tests were applied as appropriate. Mean age was 34.1 ±4.9 years, and mean BMI 29.7±5.8 kg/m2; 91 women (55.15%) had primary and 74 (44.8%) secondary infertility. CUA was found in 21 (12.7%, 95% CI 8.1-18.8%). The septate uterus predominated (16/165,9.7%), followed by the T-shaped cavity (2.4%) and bicornuate uterus (0.6%). Prevalence was similar in primary (13.2%) and secondary (12.3%) infertility (P= 0.92) and unrelated to age (P=0.60) or BMI (P=0.68). Two-dimensional TVS detected only 37.5% of hysteroscopically confirmed septa. One in eight infertile Libyan women had a congenital uterine anomaly, the septum being the most common. Concurrent hysteroscopy markedly improved detection over ultrasound alone.