| dc.description.abstract | Uterine fibroids are a common cause of infertility in sub-Saharan Africa, where assisted reproductive technology is largely unavailable and myomectomy is often the main fertility-directed treatment. Local evidence on reproductive outcomes after myomectomy in Kenya is limited. This study assessed reproductive outcomes and associated factors within two years of myomectomy among women with infertility at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). It described reproductive outcomes within two years of surgery, identified patient-related factors associated with conception, assessed the association between fibroid characteristics, selected intraoperative factors and conception, and estimated the time to confirmed pregnancy. A single-arm retrospective cohort design was used. Records of women who underwent myomectomy between January 2019 and January 2024 were reviewed, and follow-up interviews were conducted to ascertain outcomes. Of 250 records screened, 184 women were eligible and 168 (91.3%) completed follow-up. Data were analysed with IBM SPSS version 26.0 using descriptive statistics, chi-square tests, logistic regression, Kaplan–Meier analysis and Cox regression. Within two years, 54/168 (32.1%) women conceived; the cumulative probability of conception at 24 months was 35.0%. Of the 54 pregnancies, 34 (63.0%) ended in live birth and 15 (27.8%) in miscarriage. The median time to conception among women who conceived was 14.0 months (IQR 9.25–17.75). Previous uterine surgery was associated with lower odds of conception (AOR 0.47, 95% CI 0.23–0.94) and slower conception (aHR 0.50, 95% CI 0.27–0.93). Larger fibroid diameter was associated with lower odds of conception (AOR 0.85 per cm, 95% CI 0.72–0.997), although this estimate was imprecise. The largest proportion of participants, 75/168 (44.6%), were aged 35 years or older, and 129/168 (76.8%) had secondary infertility. About one-third of women conceive within two years of myomectomy, and previous uterine surgery is associated with lower and slower conception. These findings support realistic counselling, complete pre-operative fertility evaluation and structured follow-up for women undergoing myomectomy | en_US |
