Factors associated with infertility among women attending the gynaecology clinic at University Teaching Hospital

Abstract

Objectives: Infertility is a public health problem which in Africa south of the Sahara affects up to 40 percent of women. As such, infertility has devastating psychosocial consequences on affected couples. The World Health Organization estimates that there are 60-80 million infertile couples worldwide and the majority of whom are in developing countries. The objective of this study was to investigate and determine the factors associated with infertility in women attending the gynaecology clinic at the University Teaching Hospital (UTH) in Lusaka, Zambia. Methods: Women attending the gynaecology clinic for infertility were enrolled using an unmatched case-control study design. Controls were randomly selected from women in the labour ward. A preformed investigator administered questionnaire was used to collect data. Bivariate analysis was used to determine association between infertility and demographic and previous gynaecological history. Odds ratios were used to determine statistical significance. Associations with a p<0.05 or those with clinical significance were further analysed by multivariate logistic regression. Results: One hundred and thirty women were selected as cases and 260 as controls. Overall, primary infertility was found to affect 50/130 (38.5 percent) of the women while secondary infertility was found in 80/130 (61.5 percent). In multivariate logistic regression analysis, the following factors were independently associated with infertility: marital status, age at menarche, frequency of menses, ever use of contraception, ever had a manual vacuum aspiration and past pelvic procedure or infection. Though on bivariate analysis, age >35 years and partner alcohol use were associated with infertility, this was not the case in the multivariate logistic regression analysis when potential confounders were considered. The odds of a married woman having infertility was 9 times that of an unmarried woman (OR 9.09, 95% confidence interval 2.22 to 37.29). Irregular menses, was over 20 times that of a woman with regular cycles to be associated with infertility (OR 20.72, 95% CI 2.52-170.56). Past ever use of contraception was associated with 83 percent less odds of infertility (OR 0.27, 95 CI 0.14-0.57). Investigations were ordered for infertility were hormonal, HSG, ultrasound and semen analysis though in most cases the investigation was not done or results were not available. Conclusion: There was a higher proportion of secondary infertility than primary infertility in this study. Marital status, age at menarche, frequency of menses, ever use of contraception, ever had a manual vacuum evacuation and past pelvic procedure or infection were independently associated with infertility though other factors, like behavioural and weight, were not considered. It appeared that ovulation problems as manifest by irregular menses could be amenable to ovulation induction agents though suspected tubal damage (after MVA and pelvic surgery) could be problematic in treating. Few of the couples were investigated and fewer still had results available for assessment at review reflecting a need to strengthen the health system to manage couples with infertility.