Causal Factors and Management Options of Infertility in Kuwait

Abstract

Objective: To determine the main causes and management options of infertility in Kuwait. Methodology: Clinical evaluation, hormone profile of LH, FSH, prolactin and testosterone and midluteal phase progesterone, tubal patency tests, semen analysis and antisperm antibodies were assessed. Treatment included medical and surgical induction of ovulation. Male factor infertility was treated with antibiotics and immunosuppression when indicated, and empirically with antioxidants. Results: The main cause of female infertility was ovarian dysfunction (40.7%) with predominance of polycystic ovarian syndrome (52.9%), anovulatory regular cycles (25%) and hyperprolactinaemia (14.3%). Male factor accounted for infertility in 40.2% of the couples, with asthenozoospermia in 34.3%, oligozoospermia in 29.2% and azoospermia in 8.2%. Immuological tubal factors and endometriosis occurred in 9.8, 5.9 and 5.6%, respectively, and unexplained infertility in 8.5%. Both spouses were involved in 36.5% of the couples. Clomiphene citrate was the commonest agent for induction of ovulation with an 80% success rate. Bromocriptine, gonadotropins and laparoscopic ovarian cautery had success rates of 71, 69, and 80%, respectively. Treatment outcome in male factor infertility was variable. Conclusion: Ovarian dysfunction and male factor infertility are the dominant factors responsible for infertility in Kuwait. Induction of ovulation has a good prognosis of 40–80% success rate. Tubal factor infertility is uncommon in Kuwait.

Effect of maternal age on the ovarian reserve markers, and pregnancy outcome in a sample of Kurdish women in Erbil city

“…17 However, the mean age of women in this study was higher than what was reported in neighboring countries, and the Eastern Asian countries. In Kuwait, the mean age was 29.9+ 5.4 years, 18 while it was 29 + 6.0 years in Iran and 25.9 + 4.18 years in India. 19,20 The causes may be the lower educational attainment, cost issues and most importantly the delay in establishing of fertility and ART centers in our country because of the wars and civil strife for decades with minimal infrastructure and organizations.…”

“…21 A meta-analysis study in Iran reported that 78.4% of couples had primary and 21.6% had secondary fertility problems. 1 In Kuwait, 63% of the infertile women had primary infertility and 37% had secondary infertility, 18 and in Egypt the rates of primary and secondary infertility were 70.7% and 29.3% respectively among infertile couples. 22 The most comprehensive study of infertility was that of the WHO on 5800 infertile couples seeking help at 33 medical centers in 22 developed and developing countries, which revealed that the majority of infertile couples around the world suffer from primary infertility.…”

Explained infertility among the couple attending the infertility unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh

“…The present study demonstrated ovarian dysfunction as the most common cause in female infertility of which anovulatory menstrual cycle (60%) topped the list. Anovulation is also a common factor in Kuwait (25%) 8 and Iran (28.8%) 17 . Our study found women with bilateral tubal occlusion (8%) and pelvic adhesions (24%), for many women in developing countries especially in Sub-Saharan African countries suffer infertility resulting from untreated PID, a sequel of a STI or other reproductive tract infection 3,19 .…”

“…The causes of infertility vary from country to country and in the different cultural, environmental and socioeconomic groups 7 . For an example, hypothalamic -pituitary-ovarian axis disorders with anovulation are the commonest causal factors of infertility in Kuwait 8 . On the other hand, tubal factor infertility related to infection is more common in Africa, South America and India 8 .…”

“…For an example, hypothalamic -pituitary-ovarian axis disorders with anovulation are the commonest causal factors of infertility in Kuwait 8 . On the other hand, tubal factor infertility related to infection is more common in Africa, South America and India 8 .…”