Gynecology & Reproductive Medicine

Abstract

Sizes, Numbers and Distribution of Uterine Fibroids Enucleated At Laparoscopic Myomectomy from Nigerian Women with Primary or Secondary Infertility

Abayomi Ajayi, Bamgboye M. Afolabi, Victor Ajayi, Oluwafunmilola Biobaku, Ifeoluwa Oyetunji and Happiness Aikhuele

Background: Fibroids are the commonest benign gynaecological tumors affecting only females and laparoscopic myomectomy is the modern management because of its various advantages, especially among women who still desire retention of their fertility.

Materials and Methods: This is a retrospective review of 31 infertile patients who had laparoscopic myomectomy (LM) from January 2010 to December 2014 at Nordica Fertility Center. Information on socio-demographic characteristics such as age, body mass index and duration and type of infertility, marital status and parity were recorded. For the purpose of this paper, clinical data such as number of miscarriages, uterine size, site, size and number of fibroids were also noted. Data were analyzed using STATA 13 statistical software. P-value of 0.05 and below was regarded as level of acceptable statistical significance.

Results: A total of 31 women presented with fibroid for laparoscopic myomectomy. Their means (± sd) of age (years), Body Mass Index (kg/m2) and years trying to conceive (TTC) were 38.0 (5.3), 27.4 (4.6) and 5.7 (3.5) respectively. Among the patients, 13 (41.9%) and 18 (58.1%) presented with primary and secondary infertility respectively, 12 (38.7%) were professionals, 29 (93.5%) were married and 6 (19.4%) had previous uterine operation. The non-gravid uterus was significantly bulkier (weeks) in primary (18.0 ± 3.7) than in secondary (14.1 ± 2.4) infertility. Most prevalent symptoms were dysmenorrhea (53.9%,55.6%), menorrhagia (53.9%, 38.9%) and abdominal swelling (53.9%, 38.9%) respectively. Intramural fibroids were most common in both groups of women while pedunculated fibroid was exclusive to primary infertility. Highest fibroid /woman ratio of 8.7:1 was observed among women aged 46-50 years. Intramural fibroids were significantly bigger in primary than in secondary infertility (t = 1.9, P-value = 0.03). Type of infertility was a strong predictor of the size of the non-gravid uterus with fibroids (r = -0.06, Std. err. = 0.03, t = -2.26, P = 0.03, 95% CI: -0.11, -0.01). 

Conclusion: Women with primary infertility are prone to larger fibroid size and tend to have more fibroids per person while those with secondary infertility are more likely to have fibroid located in sub serous site.