December 28, 2006

Infertility - from Africa Perspective


Infertility is of particular concern in Africa because of the extent of the problem and the social stigma attached to it. The highest prevalence of infertility in Africa occurs south of the Sahara, but 5-8% of couples are estimated to experience infertility at some point in their reproductive lives (50-80 million people worldwide). The average infertility in Africa is 10.1% of couples, with a high of 32% in some countries, and certain tribes have high infertility rates. While primary infertility is higher in other regions of the world, secondary infertility is more common in Africa, and secondary infertility rates are very complicated to determine. The World Health Organization Task Force on the Diagnosis and Treatment of Infertility instituted a standardized approach to studies of infertility which was adopted in 33 countries. Between 1978 and 1982, a pilot study of this approach examined 8504 couples and found that less than 50% of male and female infertile partners were primarily infertile, and 66% did achieve a pregnancy within the union. The cause of infertility was not determined for 35% of the women and 50% of the infertile men in the sample. Infertility was accounted for by endocrine factors (usually menstrual or ovulatory disturbances) in 35% of infertile cases and tubal factors (such as unilateral or bilateral tubal occlusion, pelvic adhesion, and other abnormalities) in 32%. About 66% of African women experienced tubal factors compared to about 33% worldwide. About 9% of women reported a history of sexually transmitted disease (STD), and 8% reported abortion complications. 46% of men in sub-Saharan Africa reported a history of STDs. About 24% of women with primary infertility and 40% of women with secondary infertility had no previous history of pelvic inflammatory disease or STDs and had tubal disease. African infections are common due to inadequate health services, improper use of antibiotics, and penicillin-resistant strains of gonorrhea. Public health programs should be implemented to prevent infection-related infertility.

Worldwide patterns of infertility: is Africa different?

The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples. The study was conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world. Over 5800 couples completed the investigation. African centres had a pattern of infertility different from those in other developing regions or the developed countries. African couples were more likely than those from elsewhere to have secondary infertility or longer duration, a history of sexually transmitted diseases or pregnancy complications, and infertility diagnoses (such as bilateral tubal occlusion or pelvic adhesions) suggestive of previous genital infections.

Analysis of data from a World Health Organization-sponsored collaborative investigation of infertility indicates that Africa may have a pattern of infertility quite different from that in other regions of the world. The study, which involved over 5800 couples that had been infertile for at least 1 year, was conducted in 33 medical centers in 25 countries throughout the developing world in 1979-84. African couples were more likely to have a wide age disparity between men and women, secondary infertility of longer duration, and a history of either sexually transmitted diseases (STD) or pregnancy complications. Africa was the only region where a majority of couples (52%) had secondary infertility; secondary infertility rate was 29% in developed countries evaluated and 16-40% in the other 3 regions of the developing world. Whereas 46% of couples in developed countries sought medical evaluation for infertility before waiting 2 1/2 years, over 2/3 in developing countries (70% in Africa) had been trying to conceive for more than 2 1/2 years. 9% of African women reported a history of STD compared to 3% in developed countries and 1% of those in the other 3 regions of the developing world. Pregnancy complications, largely due to infection, were reported by 8% of African women and 7% in Latin America but by only 2% in developed countries and in Asia and the East Mediterranean. The pattern of specific causes of infertility further differentiated Africa from the other regions. Over 85% of African women had diagnoses attributed to infection, most notably bilateral tubal occlusion and pelvic adhesions. The preponderance of infection-related causes of infertility in African couples suggests a need for public health programs to reduce these causes, including STD control and education programs.

Adapted from National Library of Medcine