A 7‑Year Review of Abdominal Myomectomy for Infertile Women in Delta State: Fertility and Obstetric Outcomes

Main Article Content

Williams Obukohwo Odunvbun

Abstract

BACKGROUND: Laparoscopic myomectomy for removal of uterine fibroid in resource‑limited settings is cost prohibitive. Open abdominal myomectomy is unarguably more affordable, despite the drawbacks.


OBJECTIVE: The study aimed to determine fertility and obstetric outcomes after an open abdominal myomectomy.


MATERIALS AND METHODS: A retrospective descriptive study that involved the retrieval of medical records, and analysis of the data of women who had open abdominal myomectomy due to uterine fibroid and unexplained infertility, in a private health facility in Abraka, Delta State, Nigeria, from 1 February 2014 to 31 January 2021. The age, duration of infertility, location of fibroid masses within the uterus, history of previous pregnancy, pregnancy after myomectomy, pregnancy outcome and amongst other variables were captured and analysed using IBM SPSS version 23.


RESULTS: The data for 69 (88.5%) out of the 78 patients who had myomectomy was available for analysis. The mean age of patients was 33.3 ± 4.7 years; about 2/3 (65.5%) of the patients were ≤30 years. The pregnancy rate after myomectomy was 55.1% (38/69), most (44.9%) of the pregnancies occurred in the 1st year after myomectomy and about half (46.4%) of the patients were delivered by caesarean section. Patient’s age, shorter duration of infertility and fewer fibroid masses were significantly associated with favourable fertility outcomes (P < 0.001, P < 0.001 and P < 0.05, respectively). Age ≤30 years was most predictive of pregnancy after myomectomy, P < 0.017.


CONCLUSION: The study showed that women with uterine fibroid and unexplained causes of infertility at age ≤30 years have good fertility and obstetric outcome after open abdominal myomectomy.

Downloads

Download data is not yet available.

Article Details

How to Cite
Odunvbun, W. O. (2022). A 7‑Year Review of Abdominal Myomectomy for Infertile Women in Delta State: Fertility and Obstetric Outcomes. Journal of The Medical Women’s Association of Nigeria, 7(2), 38-41. https://doi.org/10.60787/jmwan-v7i2-42
Section
Original Article

References

Talaulikar VS, Gupta S, Manyonda I. Pregnancy after complex myomectomy: Neither age of patient nor size, number or location of fibroids should be a barrier. JRSM Short Rep 2012;3:19.

Khaund A, Lumsden MA. Impact of fibroids on reproductive function. Best Pract Res Clin Obstet Gynaecol 2008;22:749‑60.

Buttram VC Jr., Reiter RC. Uterine leiomyomata: Etiology, symptomatology, and management. Fertil Steril 1981;36:433‑45.

Daniell JF, Gurley LD. Laparoscopic treatment of clinically significant symptomatic uterine fibroids. J Gynecol Surg 1991;7:37‑9.

Oliveira FG, Abdelmassih VG, Diamond MP, Dozortsev D, Melo NR, Abdelmassih R. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization‑intracytoplasmic sperm injection. Fertil Steril 2004;81:582‑7.

Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C,et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: A randomized comparison with abdominal myomectomy. Hum Reprod 2000;15:2663‑8.

Malzoni M, Rotond M, Perone C, Labriola D, Ammaturo F, Izzo A, et al. Fertility after laparoscopic myomectomy of large uterine myomas: Operative technique and preliminary results. Eur J Gynaecol Oncol 2003;24:79‑82.

Orazulike NC, Uzoigwe SA. Fertility in women after open abdominal myomectomy at the university of Port Harcourt teaching hospital, Port Harcourt, Nigeria. East Afr Med J 2015;92:525‑9.

Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod 2002;17:1424‑30.

Kumakiri J, Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Itoh S,et al. Pregnancy and delivery after laparoscopic myomectomy. J Minim Invasive Gynecol 2005;12:241‑6.

Marchionni M, Fambrini M, Zambelli V, Scarselli G, Susini T. Reproductive performance before and after abdominal myomectomy: A retrospective analysis. Fertil Steril 2004;82:154‑9.

Soriano D, Dessolle L, Poncelet C, Benifla JL, Madelenat P, Darai E. Pregnancy outcome after laparoscopic and laparoconverted myomectomy. Eur J Obstet Gynecol Reprod Biol 2003;108:194‑8.

Landi S, Fiaccavento A, Zaccoletti R, Barbieri F, Syed R, Minelli L. Pregnancy outcomes and deliveries after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 2003;10:177‑81.

Damiani A, Melgrati L, Marziali M, Sesti F. Gasless laparoscopic myomectomy. Indications, surgical technique and advantages of a new procedure for removing uterine leiomyomas. J Reprod Med 2003;48:792‑8.

Vercellini P, Maddalena S, De Giorgi O, Aimi G, Crosignani PG. Abdominal myomectomy for infertility: A comprehensive review. Hum Reprod 1998;13:873‑9.

Somigliana E, Vercellini P, Daguati R, Pasin R, De Giorgi O, Crosignani PG. Fibroids and female reproduction: A critical analysis of the evidence. Hum Reprod Update 2007;13:465‑76.

Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril 1992;58:1‑15.

Jeldu M, Asres T, Arusi T, Gutulo MG. Pregnancy rate after myomectomy and associated factors among reproductive age women who had myomectomy at Saint Paul’s hospital millennium medical college, Addis Ababa: Retrospective cross‑sectional study. Int J Reprod Med 2021. doi: 10.1155/2021/6680112.

Chigbu B, Onwere S, Aluka C, Kamanu C, Feyi‑Waboso P, Okoro O. Fertility following myomectomy at Aba, Southeastern Nigeria. J Med Investig Pract 2014;9:136.

Dahlman M, Palmer M, Havstad S, Wegienka G, David E, Madhu B, et al. Fertility after myomectomy: A retrospective cohort study. J Minim Invasive Gynaecol 2012;19:S48‑9.

Margueritte F, Adam C, Fauconnier A, Gauthier T. Time to conceive after myomectomy: Should we advise a minimum time interval? A systematic review. Reprod Biomed Online 2021;43:543‑52.

Zhang Y, Hua KQ. Patients’ age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy. J Laparoendosc Adv Surg Tech A 2014;24:95‑9.

DesaiP, PatelP. Fibroids, infertility and laparoscopic myomectomy. J Gynecol Endosc Surg 2011;2:36‑42.

Darwish AM, Nasr AM, El‑Nashar DA. Evaluation of post myomectomy uterine scar. J Clin Ultrasound 2005;33:181‑6.

Tsuji S, Takahashi K, Imaoka I, Sugimura K, Miyazaki K, Noda Y. MRI evaluation of the uterine structure after myomectomy. Gynecol Obstet Invest 2006;61:106‑10.

Pritts EA. Fibroids and infertility: A systematic review of the evidence. Obstet Gynecol Surv 2001;56:483‑91.