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Abstract
Introduction. Le but de cette étude était d’étudier les facteurs associés à la fertilité post-myomectomie par laparotomie dans deux hôpitaux de première catégorie dans la ville de Douala, Cameroun. Méthodologie. Il s’agissait d’une étude de cohorte rétrospective incluant les dossiers des patientes ayant subi une myomectomie par laparotomie du 1er janvier 2012 au 31 décembre 2020 à l’Hôpital Général et à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Douala. Les données épidémiologiques et cliniques étaient recueillies. Les résultats ont été analysés à l’aide du logiciel SPSS version 25 et Microsoft Excel 2016. Nous avons recherché les facteurs associés à la conception post-myomectomie en utilisant les tests de Chi2 et le test exact de Fisher(n<3). Le seuil de significativité p a été fixé à 5%. Résultats. La proportion de grossesse après myomectomie était de 16,20%. Le délai moyen de conception était de 18,75±10,72 mois. Nous avons recensé 72,70% d’accouchements à terme. A l’analyse univariée, l’âge maternel entre 40 et 50 ans, et la multiplicité des incisions sur l’utérus (2,3 et 4) diminuaient les chances de conception alors que les antécédents d’avortement (≥5) les augmentaient. Après analyse multivariée, seul l’âge maternel et les antécédents d’avortements étaient associés à la fertilité. Conclusion. La fertilité après myomectomie est faible dans notre milieu. Les facteurs associés à la fertilité post-myomectomie sont l’âge compris entre 40 et 50 ans et les antécédents d’au moins cinq avortements. La réalisation de la myomectomie avant l’âge de quarante ans garantirait de meilleures chances de procréation post-myomectomie.
ABSTRACT
Introduction. The purpose of this study was to investigate the factors associated with post-laparotomy fertility in two first class hospitals in the city of Douala, Cameroon. Methodology. This was a retrospective cohort study including records of patients who underwent laparotomy myomectomy from January 1, 2012 to December 31, 2020 at the Douala General Hospital and the Douala Gyneco-Obstetric and Pediatric Hospital. Epidemiological and clinical data were collected. Results were analyzed using SPSS version 25 and Microsoft Excel 2016. We looked for factors associated with post-myomectomy conception using Chi2 tests and Fisher's exact test(n<3). The p significance level was set at 5%. Results. The proportion of pregnancy after myomectomy was 16.20%. The average time to conception was 18.75±10.72 months. We counted 72.70% full-term deliveries. At univariate analysis, maternal age between 40 and 50 years, and multiple incisions on the uterus (2,3 and 4) decreased the chances of conception, whereas a history of abortion (≥5) increased them. After multivariate analysis, only maternal age and history of abortion were associated with fertility. Conclusion. Fertility after myomectomy is low in our setting. Factors associated with post-myomectomy fertility are age between 40 and 50 years and a history of at least five abortions. Performing myomectomy before the age of forty would guarantee better chances of post-myomectomy procreation.
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References
- - De Mozata DB, Kadhel P, Janky E. Fertility, pregnancy outcomes and deliveries following myomectomy experience of a French Caribbean University Hospital, Archives of Gynecology and Obstetrics. 2014;289(3):681- 6.
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- - Ekono Michel Roger Guy, Azoumbou Mefant Thérese, NgahaYaneu Junie, Elong Adolphe Félix, AminatouYababba Moussa Gambo,,Tchente Nguefack Charlotte. Fertilité et Devenir des Grossesses Post-Myomectomie par Laparotomie à Douala (Cameroun). Health Sci. Dis: 2023 ; Vol 24 (4): 157-161.
- - Lebovitz O, Orvieto R, James KE, Styer AK, Brown DN. Predictors of reproductive outcomes following myomectomy for intramural fibroids. Reprod Biomed Online. 2019;39(3):484-91.
- - Ngo Um Meka E, Essiben F, Foumane P. Clinical psychological and socio–professional impact of uterine myomas; case of 101 women in care at the gyneco-obstetric and pediatric hospital in Yaounde Cameroon. ObstetGynecolInt J. 2019; 10(4):291-7.
- - Tiemtore-Kambou B M A, N’de/Ouedraogo N, Zanga M, Dao Ba, Ouattara B, Sanfo S et al. Étiologies Échographiques des Infertilités Féminines à Ouagadougou. Health Sci. Dis. 2016;17(3):30-34.
- - Jeldu M, Asrès T, Arusi T, GuntaGutulo M. Pregnancy rate after myomectomy and associated factors arrow reproductive age women who had myomectomy at Saint Paul’s Hospital Millenium Medical College, Addis Abeba : reproductive cross-sectional. International Journal of Reproductive Medicine. 2021; 6.
- - Rakotomahenina H, Rajaonarison JJC, Adrian Ampy H, Randriamblelomanana JA, Brun JL, Hocke G. Evaluation du pronostic obstétrical après myomectomie au service de gynécologie obstétrique du CHU de Bordeaux. JMGO. 2016;2:19-24.
- - Bang Ntamack JA, Mayi-Tsonga S, Sima Ole B, Meye J.F. Grossesse après myomectomie à Libreville, Gabon. Clin Mother Child Health. 2009;6(2): 1101- 6.
- - Chaker A, Ferchiou M, Lahmar MM, Zhioua F, Meriah S. fibromes utérins : fertilité apres myomectomie : étude comparative. A propos de 41 cas. La tunisie Médicale. 2004;12 (82) :1075-81
- - Dieme MEF, Niang MM, Gassama O. Practice of diagnostic hysteroscopy after myomectomy in the prevention of intrauterine adhesions :experience of Ouakam military hospital (Dakar, Senegal). International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018 ;7(5) : 1694.
- - Orlando M, Swapna K, Loren H, Kho R. Non-hysteroscopic myomectomy and fertility outcomes: a systematic review. The J Minim Invasive Gynecol. 2020; 10: 006.
- - 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 of LaparoendoscAdvSurg Tech. 2014;24(2):95–9.
- - Yan L, Ding L, Li C, et al. Effect of fibroids not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study. Fertil Steril. 2014;101:716–21.
- - Vilos GA, Allaire C, Laberge P-Y, Leyland N, Vilos AG, Murji A, Chen I. The Management of Uterine Leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157 178
- - Chigbu B, Onwere S, Aluka C. Fertility following myomectomy at Aba, Southeastern Nigeria. Journal of Medical Investigations and Practice. 2014 ; 9(4) :136.
- - Gavai M, Berkes E, Lazar L. Factors affecting reproductive outcome following abdominal myomectomy. Journal of Assisted Reproduction and Genetics. 2007; 24(11) : 525–531.
References
- De Mozata DB, Kadhel P, Janky E. Fertility, pregnancy outcomes and deliveries following myomectomy experience of a French Caribbean University Hospital, Archives of Gynecology and Obstetrics. 2014;289(3):681- 6.
- Somigliana E, De Benedictis S, Vercellini P, et al. Fibroids not encroaching the endometrial cavity and IVF success rate: a prospective study. Hum Reprod. 2011;26:834–839. [PubMed] [Google Scholar]
- Klatsky PC, Tran ND, Caughey AB, et al. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198:357–366. [PubMed] [Google Scholar]
- Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91:1215–1223. [PubMed] [Google Scholar]
- Oliveira FG, Abdelmassih VG, Diamond MP, et al. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on outcome of in vitro fertilization-intracytoplasmic sperm injection. Fertil Steril. 2004;81:582–587. [PubMed] [Google Scholar]
- Parazzini F, Tozzi L, Bianchi S. Pregnancy outcome and uterine fibroids. Best Practice & Research Clinical Obstetrics &Gynaecology. 2015;34:74-84.
- Coulibaly A, Sima M, Traoré MS, Kante I, Dao SZ, Kone K, et al. Place du fibrome utérin chez les patientes qui consultent pour infertilité au service de gynécologie obstétrique du CHU Point G. Rev Mal Sci Tec. 2020;1(23):17-26.
- Ekono Michel Roger Guy, Azoumbou Mefant Thérese, NgahaYaneu Junie, Elong Adolphe Félix, AminatouYababba Moussa Gambo,,Tchente Nguefack Charlotte. Fertilité et Devenir des Grossesses Post-Myomectomie par Laparotomie à Douala (Cameroun). Health Sci. Dis: 2023 ; Vol 24 (4): 157-161.
- Lebovitz O, Orvieto R, James KE, Styer AK, Brown DN. Predictors of reproductive outcomes following myomectomy for intramural fibroids. Reprod Biomed Online. 2019;39(3):484-91.
- Ngo Um Meka E, Essiben F, Foumane P. Clinical psychological and socio–professional impact of uterine myomas; case of 101 women in care at the gyneco-obstetric and pediatric hospital in Yaounde Cameroon. ObstetGynecolInt J. 2019; 10(4):291-7.
- Tiemtore-Kambou B M A, N’de/Ouedraogo N, Zanga M, Dao Ba, Ouattara B, Sanfo S et al. Étiologies Échographiques des Infertilités Féminines à Ouagadougou. Health Sci. Dis. 2016;17(3):30-34.
- Jeldu M, Asrès T, Arusi T, GuntaGutulo M. Pregnancy rate after myomectomy and associated factors arrow reproductive age women who had myomectomy at Saint Paul’s Hospital Millenium Medical College, Addis Abeba : reproductive cross-sectional. International Journal of Reproductive Medicine. 2021; 6.
- Rakotomahenina H, Rajaonarison JJC, Adrian Ampy H, Randriamblelomanana JA, Brun JL, Hocke G. Evaluation du pronostic obstétrical après myomectomie au service de gynécologie obstétrique du CHU de Bordeaux. JMGO. 2016;2:19-24.
- Bang Ntamack JA, Mayi-Tsonga S, Sima Ole B, Meye J.F. Grossesse après myomectomie à Libreville, Gabon. Clin Mother Child Health. 2009;6(2): 1101- 6.
- Chaker A, Ferchiou M, Lahmar MM, Zhioua F, Meriah S. fibromes utérins : fertilité apres myomectomie : étude comparative. A propos de 41 cas. La tunisie Médicale. 2004;12 (82) :1075-81
- Dieme MEF, Niang MM, Gassama O. Practice of diagnostic hysteroscopy after myomectomy in the prevention of intrauterine adhesions :experience of Ouakam military hospital (Dakar, Senegal). International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018 ;7(5) : 1694.
- Orlando M, Swapna K, Loren H, Kho R. Non-hysteroscopic myomectomy and fertility outcomes: a systematic review. The J Minim Invasive Gynecol. 2020; 10: 006.
- 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 of LaparoendoscAdvSurg Tech. 2014;24(2):95–9.
- Yan L, Ding L, Li C, et al. Effect of fibroids not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study. Fertil Steril. 2014;101:716–21.
- Vilos GA, Allaire C, Laberge P-Y, Leyland N, Vilos AG, Murji A, Chen I. The Management of Uterine Leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157 178
- Chigbu B, Onwere S, Aluka C. Fertility following myomectomy at Aba, Southeastern Nigeria. Journal of Medical Investigations and Practice. 2014 ; 9(4) :136.
- Gavai M, Berkes E, Lazar L. Factors affecting reproductive outcome following abdominal myomectomy. Journal of Assisted Reproduction and Genetics. 2007; 24(11) : 525–531.