Medical Case Reports

Biography

Biography: Dr INDHUMATHI SHANMUGAM

Abstract

According to WHO, infertility is defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Endometriosis, fibroid and miscellaneous conditions ( such as  PCOS, uterine anomalies) are often contributing reasons for  female infertility. 5-10% of infertile women have Fibroid but it is the only cause in 1-2.4%. Studies have suggested that 25%- 50% of infertile women have endometriosis. These are many a times associated with symptoms of dysmenorrhea, dyspareunia, deep pelvic pain, dysuria and  dyschezia. Many literatures discuss on diagnosing endometriosis , fibroid, and evolving procedures. This study focus on identifying the risk factors associated with Fibroid and Endometriosis in women with infertility and their influence on duration of infertility.

Aims and Objective: 

 To identify the risk factors influencing duration of infertility.

Materials And Methods

This is a retrospective cross sectional observational study conducted in Fertility Centre,SAT Hospital, Medical College, Thiruvananthapuram, India among Women with infertility who underwent laparoscopy during January 2017 to November 2018. Inclusion Criteria: Patients of primary or secondary infertility subjected to  laparoscopy. 102 patients were recruited and observed. The study variables taken were as under; Socio demographic factors, Menstrual history, Associated symptoms, Reproductive history, Family history of endometriosis, Life style factors ,Visual diagnosis of endometriosis using revised ASRM classification.

Among the 29 categorical study variables, 20 were dichotomous and 10 had more than 2 groups. 

Statistical analysis: 

   The relationship between infertility duration and 5 symptoms was found using the binary logistic regression. The associations of 5 symptoms of pain with diagnostic events were analysed by chisquare contingency table. The significant risk factors to predict the probability of infertility duration more than 3 years were determined by multiple linear regression analysis

Results:

In this study, out of 102 patients, 40.2% had infertility duration less than 3 years and 59.8%  had more than 3 years. 41.2% diagnosed with Fibroid, 22.5% endometriosis and  36.3% miscellaneous conditions. The duration of infertility more than 3 years in patients with endometriosis, fibroid and miscellaneous conditions were 63.5%, 55% and 57.5% respectively. 57.8% had dysmenorrhoea, 38.2%  pelvic pain and  36.3% Dyspareunia . The diagnosis of endometriosis and fibroid showed significant association with dysmenorrhea(p value 0.000) and dyspareunia(p value 0.061).  98% of endometriosis had dysmenorrhea (OR-0.02), 73% had dyspareunia(OR-0.27) compared to miscellaneous conditions.The other symptoms dysuria(0.292), pelvic pain (0.347) did not show association with diagnosis. The risk factors associated with probability of increased duration of infertility (more than 3 years) are; Frequent cycles (less than 21 days), presence of dysmenorrhea, family history of endometriosis and underweight BMI.

Conclusion:

There have been standard guidelines for managing various causes of infertility considering its duration. Identifying the significant risk factors that increase the duration of infertility, helps in early diagnosis and intervention. The knowledge on modifiable factors help in creating awareness among reproductive women. The risk  factors associated with prolonged duration of infertility according to this study were Frequent cycles (less than 21 days), presence of dysmenorrhea, family history of endometriosis and underweight BMI.