Socio-demographic and clinical characteristics of clients seeking assisted conception at Lagos State University Teaching Hospital, Ikeja, Nigeria

A decennial cross-sectional review of assisted reproductive technology in a Tertiary Hospital in Southwest Nigeria

BACKGROUND

The World Health Organization recommends that Assisted Reproductive Technology be complementary to other ethically acceptable solutions to infertility. Whereas fertility centres are increasing in number in urban regions of Africa, published reports of their performance are sparse. We present a 10-year review of assisted reproductive technology performed in a public tertiary centre in Lagos, Nigeria.

METHODS

This was a hospital-based, retrospective, cross-sectional review of 604 women, over a 10-year period that had in-vitro fertilization or in-vitro fertilization with intra-cytoplasmic sperm injection at the Institute of Fertility Medicine, Lagos State University Teaching Hospital. Data obtained were expressed in descriptive statistics and Pearson correlation was used to determine the strength of linear relationship between two continuous variables at a significance level of p < 0.05.

RESULTS

The mean age of the women was of 37.7 ± 6.2 years and 89.7% had no previous parous experience. About 27.2% of the male partners had normal seminal fluid parameters while 4.6% had azoospermia. Median serum follicle stimulating hormone of the women was 8.1 IU/L and median serum anti-mullerian hormone was 6.3 pmol/L. There was weak positive correlation between age and serum follicle stimulating hormone (r = 0.306, p < 0.001); weak negative correlation between age and serum anti-mullerian hormone (r = -0.48, p < 0.001) and very weak correlation between body mass index and serum follicle stimulating hormone (r = 0.173, p = 0.011). In-vitro fertilization and intra-cytoplasmic sperm injection was the method of fertilization used in 97.4% of the cases and 81.8% of embryos formed were of good quality. Most women (94.5%) had 2 embryos transferred and 89.9% had day-5 embryo transfer done. About 1 in 4 of the women (143/604, 23.7%) had clinical pregnancy and 49.7% of women who got pregnant had delivery of a live baby at term while 11.9% had preterm delivery of a live baby.

CONCLUSION

Despite increasing use and success of assisted reproductive technology in south-western Nigeria, there is room for improvement in clinical pregnancy rates and live birth rates post- assisted reproductive technology. Complication rates are desirably low.

Tertiary care for infertile couples: aetiological diagnoses and conventional treatment outcomes in Kisangani, Democratic Republic of the Congo

BACKGROUND

In sub-Saharan Africa, tubal factors are described as the main aetiological factors of infertility. Under these conditions, medically assisted procreation is particularly indicated. However, Assisted Reproductive Technology centres are less available. Thus, infertile couples are quickly oriented towards available alternative conventional treatments. The present study aimed to determine the aetiological factors of infertility, the outcomes of the therapeutic options offered, and the factors associated with the success of conventional treatment among infertile couples seeking tertiary care in Kisangani.

METHODS

A cross-sectional study was conducted at two tertiary health facilities in Kisangani. Infertile couples who provided consent underwent specific examinations necessary for the exploration of infertility and were treated and followed up for a minimum of 6 months. The therapeutic options that were offered were expectant attitude, medical treatment, surgical treatment or transfer to an in vitro fertilization unit. The pregnancy diagnosis was performed by ultrasound.

RESULTS

A total of 272 infertile couples underwent specific examinations, were treated and were followed up for a minimum of 6 months. Many determinant causes were mostly linked to wives rather than husbands. Overall, only 34 women among 211 who were treated became pregnant during the follow-up period; 61 couples were advised to resort to IVF or adoption, but the couples for whom expectant the attitude was indicated immediately rejected it. The patients who therapeutically succeeded at the end of the treatment were those who were younger than 35 years (OR = 2.27; 95% CI = 1.06-4.87; P = 0.017), had a duration of infertility of less than five years (OR = 6.08; 95% CI = 1.79-20.69; P = 0.001) and had secondary infertility (OR = 6.08; 95% CI = 1.79-20.69; P = 0.001).

CONCLUSION

Kisangani faces a major issue in the treatment of infertility. Treatment of patients using conventional methods is limited by the predominance of tubal factors as aetiological determinants of infertility. The low pregnancy rate found in this study provided additional evidence of this. This paper represents a serious plea to national policy-makers to encourage them to pay attention to issues surrounding infertility.

Epidemiology of infertility and characteristics of infertile couples requesting assisted reproduction in a low-resource setting in Africa, Sudan

BACKGROUND

Infertility is a big health problem worldwide. Few data exist on infertility in Sudan.

METHODS

A descriptive study was conducted to assess the pattern and the causes of infertility among couples (800) attending the University of Khartoum Fertility Centre, Saad Abualila Teaching Hospital in Khartoum, Sudan. The data on the socio-demographic characteristics of the patients, the type of infertility whether primary or secondary and the causes of infertility were extracted from the medical files retrospectively.

RESULTS

The mean (SD) age of the females was 32.4 (7.4) years while that of the males was 37.5 (7.2) years. The mean (SD) duration of infertility was 4.9(3.9) years. Five hundred and fifty one (68.9%) couples had primary infertility, while the remainder 249(31.1%) had secondary infertility. Two hundred and eighty four (35.5%) couples had male infertility, 342(42.8%) couples had female infertility. One hundred and forty seven (18.4%) couples had combined male and female infertility and in 27 (3.4%) couples the cause of infertility was not identified. Factors identified in the female infertility (342) were; anovulation (178, 52.05%), tubal factor (142, 41.52%), uterine factor (7, 2.05%) and other/combined (7, 2.05%). Azoospermia (75, 26.41%), oligozoospermia (45, 15.85%), asthenozoospermia (51, 17.96%), teratospermia (15, 5.28%) and mixed pathology (101, 35.56%) were the causes of the male infertility (n = 284). Female factors of infertility were observed more frequently among couples with secondary infertility compared with primary infertility (143/551(57.4) vs. 199/249(36.1), P < 0.001.

CONCLUSION

The current study showed a high rate of primary infertility and female factor predominates compared with male factors. Future research direction should focus on the reasons why majority of clients seek this service very late.