Risk factors of tubal infertility in a tertiary hospital in a low-resource setting: a case-control study

Abstract

Background: Infertility is the inability to sustain a pregnancy in a woman with regular (2-3 times per week) unprotected sexual intercourse for a period of 1 year. This is a major public health problem that remains underrecognised in Cameroon and most countries in sub-Saharan Africa. This study aimed at identifying the risk factors associated with tubal infertility in a tertiary hospital in Douala, Cameroon. Methods: We conducted a case-control study at the Obstetrics, Gynaecology and Radiology Departments of the Douala Referral Hospital from October 1, 2016, to July 30, 2017. We recruited 77 women with tubal infertility diagnosed using hysterosalpingography and 154 unmatched pregnant women served as controls. Data on socio-demographic, reproductive and sexual health, and radiologic assessments were collected using a pretested questionnaire. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 24.0. Logistic regression models were fitted to identify demographic, reproductive health factors, surgical, medical and toxicological factors associated with tubal infertility. The adjusted odds ratios (AOR) and their 95% confidence interval were interpreted. Statistical significance set at p < 0.05. Results: Sixty-one per cent of respondents had secondary infertility. Following multivariate logistic regression analysis, respondents who were housewives (AOR 10.7; 95% CI: 1.68-8.41, p = 0.012), self-employed (AOR 17.1; 95% CI: 2.52-115.8, p = 0.004), with a history of Chlamydia trachomatis infection (AOR 17.1; 95% CI: 3.4-85.5, p = 0.001), with Mycoplasma infection (AOR 5.1; 95% CI: 1.19-22.02, p = 0.03), with ovarian cyst (AOR 20.5; 95% CI: 2.5-168.7, p = 0.005), with uterine fibroid (AOR 62.4; 95% CI: 4.8-803.2, p = 0.002), have undergone pelvic surgery (AOR 2.3; 95% CI: 1.0-5.5, p = 0.05), have undergone other surgeries (AOR 49.8; 95% CI: 6.2-400, p = 0.000), diabetic patients (AOR 10.5; 95% CI 1.0-113.4, p = 0.05) and those with chronic pelvic pain (AOR 7.3; 95% CI: 3.2-17.1, p = 0.000) were significantly associated with tubal infertility while the young aged from 15 to 25 (AOR 0.07; 95% CI: 0.01-0.67, 0.021), those in monogamous marriages (AOR 0.05; 95% CI: 0.003-1.02, p = 0.05), as well as those with a history of barrier contraceptive methods (condom) (AOR 0.17; 95% CI: 0.03-1.1, p = 0.06) were less likely to have tubal infertility.

Infertility and associated factors in three hospitals in Douala, Cameroon: a cross-sectional study

“…Besides, the practice of voluntary induced abortion is illegal in Cameroon except for therapeutic abortions where the pregnancy could compromise or jeopardize maternal or foetal outcomes. This has led to increased complications from abortions performed by unqualified medical and non-medical staff thereby increasing the maternal morbidity from post-abortion infections (endometritis), uterine synechiae, infertility and death 12,51,52 .…”

“…More than 90% of male infertility results from low sperm count (oligospermia), poor sperm quality (teratozoospermia), or both. The factors associated with couple infertility are hypogonadotropic hypogonadism, hyperprolactinaemia, disorders of ciliary function, cystic fibrosis, infections, systemic diseases and lifestyle-related factors/diseases [10][11][12][13] . Premature ovarian insufficiency, polycystic ovary syndrome, endometriosis, uterine fibroids and endometrial polyps may play a role in female infertility 12,13 .…”

“…The factors associated with couple infertility are hypogonadotropic hypogonadism, hyperprolactinaemia, disorders of ciliary function, cystic fibrosis, infections, systemic diseases and lifestyle-related factors/diseases [10][11][12][13] . Premature ovarian insufficiency, polycystic ovary syndrome, endometriosis, uterine fibroids and endometrial polyps may play a role in female infertility 12,13 . Male infertility may be due to testicular and post-testicular deficiencies [14][15][16] .…”

Fibroids and natural fertility: a systematic review and meta-analysis

“…The following selection process is presented in FIGURE 1. Eleven studies were ultimately selected (Parazzini et al, 1996;Marshall et al, 1998;Bulletti et al, 1999;Faerstein et al, 2001;Wise et al, 2004 ;Wellons et al, 2008 ;Templeman et al, 2009 ;Johnson et al, 2012;Yasui et al, 2018 ;Karlsen et al, 2020;Egbe et al, 2020). Their main characteristics are presented in TABLE 2.…”

“…Surgery or ultrasounds were the most common method of diagnosing fibroids (n = 7). In two studies, the diagnosis was self-reported (but validated) (Marshall et al, 1998;Yasui et al, 2018) and in two studies the methodology was not explained (Karlsen et al, 2020;Egbe et al, 2020). None of the studies excluded women with submucosal lesions but data according to fibroid location were reported in only one of them (Johnson et al, 2012).…”