Causes of Infertility among 1000 Patients in Ghana

Infertility is a serious problem in Africa; affecting large number of women and causing much suffering. To address this problem an infertility clinic was opened in an isolated District General Hospital in Ghana. Statistics were kept over an 18-month period to identify the numbers of patients involved and the main cause of infertility. 1000 patients were registered during the course of twice-weekly clinics over 18 months. 118 patients (11.8%) became pregnant during this time and in 482 (48.2%) others a definite diagnosis was reached. The remaining patients were still under investigation or lost to follow-up at the end of the study period. Of the 118 pregnancies 40% had suffered from primary and 60% from secondary infertility. The duration of infertility ranged from 1 to 10 years. As expected the "successful" patients tended to be young (65% under 25 years) and to have had subfertility of limited duration (77% 4 years). 113 patients had evidence of tubal damage (43% primary and 57% secondary infertility), 63% had a history of pelvic inflammatory disease and 37% had a history of abdominal or pelvic surgery. 219 male partners were subfertile: 38% were azoospermic; 33% severely oligospermic ( 5 x 10 to the 6th power/ml); 29% moderately oligospermic (20 x 10 tot he 6th power/ml); and 40% had never fathered a child. 61 patients were anovulatory as judged by amenorrhea or an irregular menstrual cycle. 10 of them were thought to be perimenopausal. 37 patients had uterine factors (27% primary and 73% secondary). 33 women had fibroids, 2 congenital abnormalities and 2 previous subtotal hysterectomies. 52 patients had unexplained infertility, although there were associated factors in 5; 3 men refused to have seminal analysis, 1 woman had unilateral tubal block on hysterosalpingogram and 1 required dilatation of a stenosed cervix early in the study. That infertility is a serious problem in Africa is shown by the large numbers of patients registering at the clinic during the study. 60% either became pregnant or had the cause of their infertility explained. The commonest causes of infertility were male factor (45%) and tubal damage (23% of those diagnosed). This is almost certainly explained by the high rates of genital infection, encouraged by prevailing sexual ethics and poor health facilities. Health education has an essential role to play in the prevention of fertility problems-- both in over and underfertility.