Pharmacotherapy of infertility in Ghana: retrospective study at the cape coast teaching hospital

Abstract

BackgroundInfertility is a major challenge for couples globally. Due to low income levels and the high cost of other assisted reproductive techniques, pharmacotherapy remain the major first line treatment option for infertility in Sub-Saharan Africa.ObjectiveThe aim of this study was to assess the prevalence of infertility as well as the effectiveness and success achieved following infertility pharmacotherapy at the Cape Coast Teaching Hospital in Ghana.MethodsThis study was a retrospective observational study of 825 couples attending infertility clinic at the hospital.ResultsPrevalence of infertility at the study center was estimated to be 12.3%. Treatment mainly involved the use of clomiphene citrate, antioxidants, herbo-mineral drugs (Ayurveda), multivitamin and antibiotics. Pharmacotherapy resulted in successful conception in one out of every five couples (19.4%; n = 160). Secondary infertility, although more prevalent in the study population (44.8%; n = 370), had lower conception rates during pharmacotherapy than primary infertility (15% vs 26.2%). Age, kind of infertility, employment status but not educational level were significantly associated with pharmacotherapy success. In ovulation induction, clomiphene citrate plus folic acid and vitamin E adjuncts improved ovulation rates during cycle treatments compared to clomiphene citrate alone. Pharmacotherapy of idiopathic infertility (39%, n = 323) was a major challenge with very limited success rates. Interestingly, it was noted that treating couples or female partners only for idiopathic infertility resulted in higher success rates than treating the male partner only. Again, 90-day treatment regimen doubled conception rates when compared with corresponding 30-day treatment regimen. However, zinc sulfate even in short term treatment regimens (30 days) enhanced conception rates in idiopathic infertility.ConclusionsPrevalence of infertility was estimated to be about 12.3%. One out of every five infertile couples achieved success with pharmacotherapy. Factors such as age, type of infertility, employment status, but not education were significantly associated with treatment success.

Pharmacotherapy of infertility in Ghana: Why do infertile patients discontinue their fertility treatment?

“…Among the healthcare professionals interviewed were doctors and nurses from the four fertility centers who provided direct care to the patients. The respondents expressed diverse views on the factors that influenced discontinuation of infertility treatment in Ghana, which were not discovered in our previous study since it relied on secondary data [ 16 ]. It is evident from this qualitative study that patients who discontinued treatment cited various reasons to back their actions.…”

“…This is partly due to the fact that most fertility experts/researchers in the sub-region are concerned with positive treatment outcomes, and tend to ignore clients who may decide to stop treatment. Our previous study which assessed the outcome of pharmacotherapy among infertile couples revealed that approximately 19.4% of them conceived after going through drug treatment [ 16 ]. However, the retrospective nature of that study made it impossible to assess how clients complied with treatment and the reasons for non-compliance, particularly in the patients who had unsuccessful treatment outcomes.…”

Knowledge, Attitude, and Perceptions about In Vitro Fertilization (IVF) among Women of Childbearing Age in Cape Coast, Ghana

“…In addition, the source of information regarding ART's availability to clients had a significant effect on their choice to employ ART services. Electronic (Internet, TV, and radio) and print (magazines and newspapers) sources of information regarding the availability of ART services in Ghana are available, as are satisfied clients, friends, and members of social networks [ 8 , 19 , 20 ]. Also, in another study, it is reported that the helpful sources of information for infertility are written health center information on childlessness and the subsequent discussion with fertility clinic staff.…”

“…Globally, about 10–15% of reproductive-age females are unable to naturally get pregnant within a year of unguarded sexual intercourse [ 8 ], and the phenomenon of infertility effect is between 60 and 168 million people worldwide [ 4 ], accounting for about 13 to 15% of couples [ 9 ]. Also, a study reported that infertility accounts for about one-third of the population in the sub-Saharan African region [ 10 ].…”

Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana

“…In Ghana, the estimated prevalence of infertility ranges from 12 to 17% (Arhin et al, 2019; Fledderjohann & Johnson, 2016; Geelhoed et al, 2002; Larsen, 2000) with male factor infertility and tubal damage reported as the most common causes (Fiander, 1990). However, data are limited, with no national-level estimates based on a clinical definition of infertility (i.e., the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce) (Zegers-Hochschild et al, 2017), which is a more informative measure for estimating the potential need for clinical care.…”