Madziyire Mugove G, Magwali Thulani L, Chikwasha Vasco, Mhlanga Tinovimba
Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Department of Community Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Fertil Res Pract. 2021 Jan 5;7(1):1. doi: 10.1186/s40738-020-00093-0.
Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care.
A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15. A total of 216 women were recruited.
Of the 216 women recruited, two thirds (144) of them had primary infertility. The overall period of infertility ranged from 1 to 21 years with an average of 5.6 ± 4.7 years whilst 98 (45.4%) of the couples had experienced 2-4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was 'unexplained' in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had Assisted Reproduction Techniques (ART) in the form of Invitro-fertilisation/Intracytoplasmic Sperm Injection (IVF/ICSI) or Intra-Uterine Insemination (IUI). Assisted Reproduction was significantly associated with conception.
Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal blockage, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal blockage, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.
全球有4850万对夫妇受不孕症影响。临床上将其定义为规律无保护性交12个月及以上仍未受孕。不同人群中各种病因对不孕症的影响各异。津巴布韦尚未对不孕症的病因进行评估。我们的目标是确定前来接受不孕症治疗的女性的生殖特征、病因及治疗结果。
对在哈拉雷的私立和公立医疗机构中，无保护性交一年仍未受孕的女性进行回顾性和前瞻性研究。根据病史、检查及结果进行诊断，只要认为这些信息足够。使用STATA SE/15对数据进行分析。共招募了216名女性。
在招募的216名女性中，三分之二（144名）为原发性不孕症。不孕的总时长为1至21年，平均为5.6±4.7年，其中98对（45.4%）夫妇经历了2至4年的不孕，94对（43.5%）经历了5年及以上的不孕。约五分之一的女性月经周期不规律，其中10人经历了至少1年的闭经。近一半的参与者（49%）超重或肥胖。不孕症最常见的原因是22%的女性为“不明原因”，其次是20%的输卵管堵塞、19%的男性因素和16%的无排卵。在49名（22.7%）受孕的女性中，21名（9.7%）活产，23名（10.7%）在随访结束时仍在妊娠。37名（17.1%）接受了体外受精/卵胞浆内单精子注射（IVF/ICSI）或宫内人工授精（IUI）形式的辅助生殖技术（ART）。辅助生殖与受孕显著相关。
大多数女性就诊时自然受孕的几率已大幅降低。本研究表明，输卵管堵塞、男性因素和不明原因不孕的比例几乎相同。几乎一半的病因是女性因素，包括输卵管堵塞、无排卵以及两者的混合。改善辅助生殖技术的可及性将提高妊娠率。相关项目应针对对双方进行全面评估并提供辅助生殖技术。
