The pattern of laparascopic findings and management offered to women with infertility at the Kenyatta National Hospital 2009-2013:A retrospective cross sectional study

Abstract

Background Infertility is a common condition with important medical and socioeconomic implications. Infertility affects 10 to 15 percent of reproductive-aged couples worldwide. In Kenya the exact magnitude is not known although according to the Infertility in Kenya Survey Report 2008, gynecologists spent 31% of their consultations on infertility in both Kenyatta National Hospital and Moi Teaching and Referral Hospital, the two largest hospitals in Kenya. Laparoscopy is the gold standard approach for direct inspection and assessment of pelvic pathology. It allows both diagnosis and immediate surgery for conditions such as tubal blockage, pelvic adhesions and endometriosis. Methodology The main objective of this retrospective cross sectional study was to describe the pattern of laparoscopic findings and management offered to women with infertility at the Kenyatta National Hospital. A total of 402 patients’ records of women with infertility who underwent laparoscopy between January 2009 and December 2013 were analyzed. The information in the records was retrieved using a pre-tested and precoded data retrieval form. Data entry was made and analyzed after verification using SPSS version 21.0 Results The mean age of the women with infertility was 32.0 years which shows an increasing age shift. The main laparoscopic finding were tubal blockage (74.40%), endometriosis (11.20%) and genital tuberculosis (5.22%). Genital Tuberculosis, pelvic adhesions and endometriosis were the intra-operative diagnoses most likely to be missed pre-operatively with kappa values of 0.0, 0.002 and 0.1 respectively. Nearly a third of all patients (29.67%) were eventually recommended to pursue Assisted Reproductive Technologies (ART) services. Conclusion and Recommendations There is a shift in the mean age of women with infertility therefore prompt evaluation and appropriate care is critical. Tubal blockage is an important cause of infertility as are endometriosis and genital tuberculosis. There should be a standardized way of evaluating and reporting laparascopic findings such as endometriosis since this has implications on management.The general evaluation of women with infertility should include endometriosis and genital tuberculosis.There is need for affordable low cost ART services in Kenya as envisioned in the National Reproductive Health Strategy 2009-2015 in KNH since it is not only the premier referra