Intrauterine adhesion is a more prevalent finding at hysteroscopy than sub mucous fibroid or polyps among infertile sub-Sahara African Women presenting for In-vitro Fertilization who have had previous uterine surgical procedures: A 15-year study.
Ajayi A. B1, AjayiV.D1 and Afolabi B.M2.
1Nordica Fertility Center, 106-108 Norman Williams Street, Southwest Ikoyi, Lagos, Nigeria
2Health, Environment and Development Foundation, 18 Ogunfunmi Street, Surulere, Lagos, Nigeria
Correspondence:
Dr. Victor Ajayi
Nordica Fertility Center,
106-108 Norman Williams Street, Southwest Ikoyi, Lagos, Nigeria
Abstract:
Objective: To determine which specific previous uterine surgical procedures was likely to have deleterious hysteroscopic findings and how much more likely.
Methodology: This was a retrospective study in which case records of 1631 Black African women who presented for ART from 2003 to 2018 were examined. Analysis was conducted with STATA 13 statistical software.
Results: The means of age (years) and BMI (Kg/m2) were 38.7 (6.4) and 28.1 (5.3) respectively. Those who never had uterine surgery (n=276, 16.9%) were significantly younger (t-test=5.10, P-value=0.0000001) than those who had had uterine surgery (D and C, Caesarean C/S and myomectomy) (n=1,355, 83.1%). There was a significant variation (t=-4.32, P-value=0.0000001) in the mean duration of subfertility (years) among women who had no uterine surgery (5.9±5.0) and those who did (7.4±5.3). Sub-fertile women who had undergone various uterine surgeries (n=200, 14.8%) were 4.7 times more likely to present with intrauterine adhesions (IUA) (χ²=51.6, P-value=0.0.0000001, OR=4.73, 95% CI: 2.99, 7.50), 1.89 times more likely to present with polyps at hysteroscopy compared with women who had not undergone surgeries (χ²=14.55, P-value=0.0.001, OR=1.89, 95% CI: 1.36, 2.64), Conversely, Pooled analysis showed substantial variation (χ²=132.32, P-value=0.0000001) in the proportion of women who had pre-hysteroscopic D&C only and various hysteroscopic findings with IUA observed as having the highest prevalence (32.0%), followed by fibroid (14.5%) and uterine polyps (10.1%). Intrauterine adhesion was also most prevalent (41.8%) among women who had pre-hysteroscopic D&C and myomectomy (χ²=82.84, P-value=0.0000001) and among those who had multiple pre-hysteroscopic surgical procedures such as D&C, C/S and Myomectomy
Conclusion: IUA was most prevalent among sub-fertile women especially among those who had undergone previous uterine surgical procedures of D&C, C/S and myomectomy. History of uterine surgical procedures and hysteroscopy among those presenting for fertility management is important.
Key words: Hysteroscopy, uterine surgical procedures, intra-uterine adhesions, Black African women.