Tropical Journal of Obstetrics and Gynaecology

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 35  |  Issue : 3  |  Page : 244--248

Pattern of infertility among infertile couple in a secondary health facility in Delta State, South South Nigeria


WO Odunvbun1, DV Oziga2, LO Oyeye2, CL Ojeogwu3,  
1 Department of Obstetrics and Gynaecology, College of Health Sciences, Delta State University, Abraka, Nigeria
2 Department of Obstetrics and Gynaecology, Eku Baptist Government Hospital, Eku, Delta State, Nigeria
3 Department of Family Medicine, Eku Baptist Government Hospital, Eku, Delta State, Nigeria

Correspondence Address:
Dr. WO Odunvbun
Department of Obstetrics and Gynaecology, College of Health Sciences, Delta State University, Abraka, Delta State
Nigeria

Abstract

Background: Infertility is a worldwide problem, affecting 8%–15% of couples in their reproductive age. There is a wide variation in the pattern of infertility in different parts of the world, being highest in the infertility belt of Africa, which includes Nigeria. Materials and Methods: This was a retrospective descriptive study, involving infertile couples attending the gynaecology clinic of Eku Baptist Government Hospital, a secondary health facility in Delta. The study was conducted from January 1, 2015, to December 31, 2015. Case notes of all eligible couples attending the gynecology clinic were retrieved; relevant information was extracted and subsequently analyzed. Results: The incidence of infertility was 32.0%. The mean age of infertile women was 34 ± 6 years, mean duration of infertility was 5 ± 3 years, 58.9% of women had secondary infertility, 56.0% of male partners of women had abnormal seminal pattern, resulting in a high (40.6%) contribution of male factor to infertility in our study. Conclusion: This study has established a 32.0% institutional incidence rate of infertility in Delta State, similar to the findings in other parts of the country. It has also confirmed the predominance of secondary infertility in this part of the country. The high level of abnormal seminal pattern in this study was responsible for the high male factor contribution to infertility in the study area.



How to cite this article:
Odunvbun W, Oziga D, Oyeye L, Ojeogwu C. Pattern of infertility among infertile couple in a secondary health facility in Delta State, South South Nigeria.Trop J Obstet Gynaecol 2018;35:244-248


How to cite this URL:
Odunvbun W, Oziga D, Oyeye L, Ojeogwu C. Pattern of infertility among infertile couple in a secondary health facility in Delta State, South South Nigeria. Trop J Obstet Gynaecol [serial online] 2018 [cited 2019 Jul 17 ];35:244-248
Available from: http://www.tjogonline.com/text.asp?2018/35/3/244/251957


Full Text

 Introduction



Infertility is the inability of a couple to conceive following 12–24 months of exposure to pregnancy.[1] It is expected that 50.0% of women could conceive within 3 months of regular unprotected intercourse, 75.0% in 6 months, and 80.0%–85.0% within a year.[2]

Infertility is a sensitive issue in our environment and it is a source of stigma.[3],[4],[5]

Infertility is a worldwide problem, affecting 8.0%–15.0% of couples in their reproductive age.[6],[7] There is a wide variation in the incidence of infertility, in different parts of the world, being highest in the so-called infertility belt of Africa, which includes Nigeria.[8] Institutional-based studies in some part of Nigeria within the last decades reveal an incidence rate of 4.0% 11.2%, and 48.1%, respectively, from Ilorin (North Central), Abakaliki (South East), and Oshogbo (South West).[9],[10],[11]

Male and female partners contribute variably to infertility in a relationship. Infertility is an underlying pathology, with female factors contributing 30.0%–40.0% of causes, male factors about 30.0%–40.0%, while both factors and unexplained infertility account for 20.0%–40.0%.[12],[13],[14]

Globally, most infertile couples suffer from primary infertility.[1] In Africa, secondary infertility predominates, and this is attributable to a high incidence of sexually transmitted disease, complications of unsafe abortions, and puerperal sepsis.[8],[15]

Seminal-tract infections play major contributory roles in male infertility and affects fertility via various mechanisms, including impairing spermatogenesis, sperm function, and obstruction of seminal tract.[13],[16],[17] Other factors that may lead to male infertility include varicocoele, endocrine disturbance, immunological conditions, and sexual dysfunction.[12],[18]

The aim/objective of the study, therefore, is to examine the pattern of infertility among infertile couples attending Eku Baptist Government Hospital and determine the incidence of infertility.

 Materials and Methods



This was a retrospective descriptive study, involving infertile couples attending the gynaecology clinic of Eku Baptist Government Hospital, a busy secondary health Facility serving the Niger Deltans in South South Nigeria. The study was conducted from January 1, 2015, to December 31, 2015. Case notes of all eligible couples attending the gynecology clinic during the study period were retrieved and relevant information extracted and transferred onto a pro forma for subsequent computer data analysis.

Inclusion criteria

All infertile couples attending the gynecology clinic (for determination of incidence)All infertile couples that completed their infertility investigations (for determination of pattern of infertility).

The pro forma included provisions for age of respondents and clinical characteristics: history of previous conception, duration of infertility, seminal pattern, causes of female infertility, and contribution to infertility by the couple.

Fertility workup was made up of hormone assay (for day 3, follicle-stimulating hormone, luteinizing hormone, prolactin, estrogen, progesterone and testosterone); hysterosalpingography; transvaginal ultrasound scan (to assess for polycystic ovaries, leiomyoma, endometrial plate integrity, and other pelvic pathologies), and semen analysis.

The semen analysis was according to the methods and standard outlined by the WHO, 2010.[19]

The operational definitions were:

Normospermia: Sperm count of 15 million per milliliter and aboveOligospermia: Sperm count of below 15 million per milliliterAzoospermia: Absence of spermatozoa in the ejaculateAsthenozoospermia: Reduced sperm motility – <40.0%Teratozoospermia: Reduced sperm morphology – <4.0%.

Oligoasthenoteratozoospermia (OAT) is the condition where all variables – count, motility, and morphology are abnormal.

Data analysis

Data collected were analyzed using the Statistical Package for the Social Sciences software version 22 (IBM Inc., Chicago, IL, USA). Analysis of variables was summarized using means and standard deviations. Frequencies and proportion were used for qualitative variables.

Ethical consideration

Ethical approval was obtained from the Ethics Committee of Eku Baptist Government Hospital (ADME: 201) and pro forma was made anonymous for confidentiality.

 Results



During the study period, a total of 678 new gynecology cases were seen, out of which 215 cases were for infertility, giving an incidence of 32.0%. Only 180 (84.0%) completed their fertility workup, and therefore available for analysis.

The mean age of the women was 34 ± 6 years, with a range of 16–45 years. Fifty-five (30.6%) women were in the age range of 26–30 years, followed by 49 (27.2%) who were within the 21–25 years' age group. Only 5 (2.8%) women were 20 years or below [Table 1].{Table 1}

The mean duration of infertility was 5 ± 3 years, with a range of 1–12 years. Sixty-one (33.9%) had 4–6 years of infertility. About 70.0% or 120 of the women had infertility spanning 1–6 years. 28 (15.6%) had infertility of up to 10 years and above [Table 2].{Table 2}

[Figure 1] shows that 106 (58.9%) of the subjects had secondary infertility, while 74 (41.1%) had primary infertility.{Figure 1}

Spermatozoa pattern in [Table 3] shows that 79 (44.0%) male partners had normal sperm parameters and 56.0% had abnormal spermatozoa pattern. Nearly 25.0% had oligospermia, 11.0% with asthenozoospermia, 10.0% teratozoospermia, 7.0% with OAT, and 6 (3.0%) of the men had azoospermia.{Table 3}

Tubal obstruction accounted for 42.0% of female factor in fertility. Uterine factor was the finding in 35 (30.0%) women, while ovarian factors were responsible for 28.0% of female factor infertility [Table 4].{Table 4}

Male factor infertility was the only pathology in 73 (40.6%) of the couples. In 31.1% of the women, only female factors were found, while in 28 (15.6%), both male and female factors were identified. Approximately 13% (12.7%) of couples had unexplained infertility [Table 5].{Table 5}

 Discussion



The 32.0% incidence rate of infertility in this study is consistent with the different rates reported in institutional-based studies conducted in the country.[9],[10],[11] Our rate is higher than findings in the North Central and South East, but lower than that in the South West, with a rate of 48.1%.[11] These rates are influenced by sample sizes and cultural differences: In our study, the high contribution of male factor may be related to some sociocultural practices that need to be determined.

The mean age of 34 ± 6 years is similar to the 33.8 ± 5.2 years in a study conducted in Lagos by Adegbola andAkindele.[20] These rates are, however, higher than rates of 31 ± 8.8 and 27.5 ± 9.2 in a study conducted in India.[21] The reason(s) for these differences is not obvious. Cultural practices that influence the age of marriage could be a contributor. The quality of oocyte, however, begins to decline from a woman's mid-30s, and in terms of her ovarian reserve, she has 12.0% of her reserve at age 30 and only 3.0% at age 40.[22]

The mean duration of infertility of 5 ± 3 years is slightly longer than the 4.1 ± 3 years reported in Calabar by Ekere et al.[23] Reasons for the delayed presentation range from patronage of faith-based health practitioners to presentation at tradomedical healers, with the latter often resulting in the complication of clinical conditions at presentation of patients.

The predominance of secondary infertility among Africans was replicated in our study. Though the 59.0% secondary infertility in this study was lower than the rates of 67.2% and 73.2% that were reported from Northwest and Southwest Nigeria and 71.6% from Northern Ghana, respectively.[24],[25],[26] The higher incidence of secondary infertility, in comparison with the more developed parts of the world, is due to the high incidence of genital tract infection among Africans.[8],[15]

The 56.0% incidence of abnormal semen pattern in our study is higher than the findings by Tabong and Adongo [26] at Ekiti in which 38.2% of the women had abnormal seminal profile. The reason for this difference is not obvious. This high incidence resulted in a high (40.6%) contribution of male factor to infertility in our study. Sperm abnormality is usually associated with distortion in the process of spermatogenesis, which could be pretesticular (hormonal), testicular (chromosomal) or post-testicular (disorder in transportation, ejaculation, and infections).[4],[16],[17] Single-factor abnormalities such as low sperm count-oligospermia (25%) and poor motility-asthenozoospermia (11%) are regarded as the leading causes of male infertility in the literature.[17],[27],[28] The presence of male factors, especially multiple male factor abnormality, could be associated with poor outcome with conventional methods in the treatment of infertile couples.[29]

Tubal factor is reported to account for 25%–35% of subfertility in Western literature.[30] The 42% tubal occlusion, we found in our study, is lower than the 63.6% in the northern part of Nigeria.[24] Proximal tubal obstruction secondary to tubal spasm or intratubal debris may be a reversible condition. Pelvic inflammatory disease is a major clinically unsuspected reason for tubal infertility.[30]

The 40.6%, male factor infertility in our study, was higher than the 34.5% from Calabar and the 19.7% from the North, respectively.[23],[24] Infective reasons have been variously cited for male factor infertility.[14],[16],[17] There could be other undetermined etiological factors responsible for the high abnormal seminal pattern in this study.

 Conclusion



This study has established a 32% institutional incidence rate of infertility in Delta State, similar to the findings in other parts of the country. It has also confirmed the predominance of secondary infertility in this part of the country, similar to what is obtainable elsewhere. The high level of abnormal seminal pattern in this study is responsible for the high contribution of male factor to infertility in the study area, a finding that raises the need for further work on possible etiological factors for the high abnormal seminal pattern.

Limitations

This was a retrospective study with a relatively small sample size. Laparoscopy and dye test would have been useful investigative procedure in our study. This was however not available in this center.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Evers JL. Female subfertility. Lancet 2002;360:151-9.
2Padubidri VG, Daftary SN. The pathology of conception. Howkins & Bourne: Shaw's Textbook of Gynaecology. 15th ed. New Delhi: Elsevier, A Division of Reed Elsevier India Private Limited; 2011. p. 197-220.
3Orhue A, Aziken M. Experience with a comprehensive university hospital-based infertility program in Nigeria. Int J Gynaecol Obstet 2008;101:11-5.
4Owolabi AT, Fasubaa OB, Ogunniyi SO. Semen quality of male partners of infertile couples in Ile-Ife, Nigeria. Niger J Clin Pract 2013;16:37-40.
5Umeora OJ, Igberase GO, Okogbenin SA, Obu ID. Cultural misconception and emotional burden of infertility in South-East Nigeria. Internet J Gynecol Obstet 2009;10:2.
6Kamel RM. Management of the infertile couple: An evidence-based protocol. Reprod Biol Endocrinol 2010;8:21.
7Obuna JA, Ndukwe EO, Ugboma HA, Ejikeme BN, Ugboma WE. Clinical presentation of infertility in an outpatient clinic of a resource poor setting, South-East Nigeria. Internet J Trop Dis Health 2012;2:123-31.
8Ezeh AC, Mberu BU, Emina JO. Stall in fertility decline in Eastern African countries: Regional analysis of patterns, determinants and implications. Philos Trans R Soc Lond B Biol Sci 2009;364:2991-3007.
9Abiodun OM, Balogun OR, Fawole AA. Aetiology, clinical features and treatment outcome of intrauterine adhesion in Ilorin, central Nigeria. West Afr J Med 2007;26:298-301.
10Umeora OU, Ejikeme BN, SundayAdeoye I, Umeora MC. SocioCultural impediment to male factor infertility evaluation in rural SouthEast Nigeria. J Obstet Gynecol 2008;28:323-6.
11Adeyemi AS, Adekanle DA, Afolabi AF. Pattern of gynaecological consultations at Ladoke Akintola university of technology teaching hospital. Niger J Clin Pract 2009;12:47-50.
12Ugboma HA, Obuna JA, Ugboma EW. Pattern of seminal fluid analysis among infertile couples in a secondary health facility in South-Eastern Nigeria. Res Obstet Gynaecol 2012;1:15-8.
13Jajoo S, Kalyani RR. Prevalence of abnormal semen analysis in patients with infertility at a rural set up in central India. Int J Reprod Contracept Obstet Gynecol 2013;2:161-4.
14Shaikh AH, Khalique K, Tang G, Soomro N. Pattern of semen abnormalities in couples with male factor infertility. Pak J Surg 2011;27:204-98.
15Nwajiaku LA, Mbachu II, Ikeako L. Prevalence, Clinical pattern and major causes of male infertility in Nnewi, South East Nigeria: A five year review. Afr Med J 2012;3:1-4.
16Butt F, Akram N. Semen analysis parameters: Experiences and insight into male infertility at a tertiary care hospital in Punjab. J Pak Med Assoc 2013;63:558-62.
17Ugwuja EI, Ugwu NC, Ejikeme BN. Prevalence of low sperm count and abnormal semen parameters in male partners of women consulting at infertility clinic in Abakaliki, Nigeria. Afr J Reprod Health 2008;12:67-73.
18Monavari SH, Vaziri MS, Khalili M, Shamsi-Shahrabadi M, Keyvani H, Mollaei H, et al. Asymptomatic seminal infection of herpes simplex virus: Impact on male infertility. J Biomed Res 2013;27:56-61.
19World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. Geneva, Switzerland: WHO Press; 2010. p. 7-113.
20Adegbola O, Akindele MO. The pattern and challenges of infertility management in Lagos, Nigeria. Afr Health Sci 2013;13:1126-9.
21Kumar D. Prevalence of female infertility and its socio-economic factors in tribal communities of central India. Rural Remote Health 2007;7:456.
22Balasch J, Gratacós E. Delayed childbearing: Effects on fertility and the outcome of pregnancy. Curr Opin Obstet Gynecol 2012;24:187-93.
23Ekere PD, Archibong EI, Bassey EE, Ekabua JE, Ekanem EI, Feyi-Waboso JE. Infertility among Nigerian couples as seen in Calabar. Port Harcourt Med J 2007;2:35-40.
24Panti AA, Sununu YT. The profile of infertility in a teaching Hospital in North West Nigeria. Sahel J 2014;17:7-11.
25Sule JO, Erigbali P, Eruom L. Prevalence of infertility in women in Southwestern Nigerian community. Afr J Biomed Res 2008;11:225-7.
26Tabong PT, Adongo PB. Understanding the social meaning of infertility and childbearing: A qualitative study of the perception of childbearing and childlessness in Northern Ghana. PLoS One 2013;8:e54429.
27Ojiyi EC, Dike EI, Anolue BU, Uzoma OI. Male factor subfertility at Imo state university teaching hospital, Orlu. Internet J Gynaecol Obstet 2012;17:1-6.
28Adeniji RA, Olayemi O, Okunlola MA, Aimakhu CO. Pattern of semen analysis of male partners of infertile couples at the university college hospital, Ibadan. West Afr J Med 2003;22:243-5.
29Peter AO, Temi AP. Pattern of semen parameters, and factors associated with infertility in male partners of infertile couples in Nigeria. Andrology (Los Angel) 2016;5:161. [doi: 10:4172/2167-0250,1000162].
30Patil M. Assessing tubal damage. J Hum Reprod Sci 2009;2:2-11.