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

Abstract

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.

The burden of infertility in North-Eastern Democratic Republic of Congo, a High-Fertility Region: A Cross-Sectional Study

“…Among women experiencing infertility, 78.78% had secondary infertility, while 21.22% had primary infertility. The results of this study are in agreement with those of Bosenge et al [24] in Kisangani, who reported that 67% of infertile couples had secondary infertility and 33% primary infertility. These ndings are consistent with those from other Sub-Saharan African countries [16, 21,26,33].…”

“…However, the uterine and tubal factors were not found to be associated with any type of infertility. In a similar study, Bosenge-Nguma et al [24] found ovarian factors among 35.2% of patients, uterine factors among 31.5% of patients and tubal factors among 46.3% of patients. In previous studies, Nguma et al [25] in Kisangani and Kalume et al [26] in Goma found that 67.6% and 73.31% of infertile women had globally a tubal issue, respectively.…”

“…The mean age of infertile women was found to be 33.91 ± 6.69 years, while the mean age of infertile men was 41.33 ± 6.05 years. In Kisangani, Bosenge-Nguma et al [24] found a mean age of 32.85 ± 6.02 years for women, while Mubikayi et al [21] in the southern region of the country reported a mean age of 33.85 ± 5.82 years. In the western of the DRC, Mboloko et al [36] found a mean age of 33.85 ± 5.82 years region of Kinshasa, while in the southern region of the country, Mubikayi et al [21] found a mean age of 33.7 ± 5.2 years.…”

“…In 27.53% of cases, the cause of infertility remained unexplained. A study conducted in Kisangani by Bosenge-Nguma et al [24] revealed that 31.62% of couples were infertile due to male factors alone, 39.71% due to female factors, and 13.23% due to a combination of male and female factors. In 15.44% of cases, the cause of infertility remained unexplained.…”

“…The causes and types of infertility vary across different African countries [23,]. In the DRC, secondary infertility is the predominant form [24]. Among women, tubal affections are commonly reported, with a prevalence ranging from 67.6-73.31% [25,26].…”