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
referral and teaching hospital in the country and region but also the largest hospital in eastern
Africa.