Trop Doct 2008;38:243-244
doi:10.1258/td.2007.070125
© 2008 Royal Society of Medicine Press
Clinical patterns and major causes of infertility among Sudanese couples
Elsir A Elussein *
Yagoub M Magid *
Maha M Omer *
Ishag Adam 
* Khartoum Fertility Center, Khartoum;
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, PO Box 102, Khartoum, Sudan
Correspondence to: Dr Ishag Adam, Khartoum Fertility Center, Khartoum, Sudan Email: ishagadam{at}hotmail.com
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SUMMARY
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An understanding of the medical causes of infertility is crucial
in order to reduce incidences of Infertility and for improving
the clinical management of infertility. Although there were
much data on infertility in other African countries, no data
exist on infertility in Sudan. Seven hundred and ten Sudanese
couples were investigated for the infertility in Khartoum Fertility
Center, Sudan: 443 (62.4%) had primary infertility and 267 (37.6%)
had secondary infertility. The mean (standard deviation) duration
of the infertility was 5.2 (4.3) years. A positive male factor
alone was found in 257 (36.2%) couples and a female factor in
350 (49.3%) couples: eleven (1.5%) couples had a combination
of male and female factors: and the cause of infertility was
unexplained in 92 (13.0%) couples. Oligozoospermia and asthenozoospermia
were factors responsible for 16.8% and 17.5% of male infertility,
respectively. Failure of ovulation (60.3%) was the most common
cause of female infertility. The study revealed a high proportion
of secondary infertility and a greater contribution of the female
factors to infertility.
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Introduction
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Infertility is a wide world problem, almost 15% of couples suffer
from infertility.
1 The World Health Organization reported that
African couples have a pattern of infertility different from
those in other developing regions or the developed countries.
They are more likely to have: secondary infertility for a longer
duration; a history of sexually transmitted diseases; or pregnancy
complications.
2 There are few studies on infertility in sub-Saharan
Africa. Sub-Saharan countries tend not to research infertility
because of economic reasons and, possibly, the psychological
denial of the problem.
3–5 The epidemiology of infertility
is important for health researchers as well as for policy makers.
A better understanding of the medical causes of infertility
is therefore crucial for reducing the incidence of infertility
and for the improvement of its clinical management. This report
is necessary as, while there is a large amount of data on infertility
in other African countries
6,7 no data exist about infertility
in Sudan, the biggest country in Africa with a population of
40 million.
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Patients and method
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We reviewed the medical files of infertile couples who presented
to the Khartoum Fertility Center, Sudan, during March to December
2004. The data obtained included the type, duration and causes
of infertility and the age of the couples involved. Couples
were investigated if they failed to conceive after more than
one year of unprotected sexual activity. Investigation of the
couples included a detailed history and a physical examination.
Semen was provided for investigation by masturbation in the
centre (or at home in exceptional cases) after three days of
abstinence and was investigated within one hour by the conventional
manual method using a haemocytometer chamber for counting. Normal
semen was taken as sperm count of 20 million and above with
>50% motility (active) and >60% of normal morphology.
For the female partner, in addition to the basic investigative
reproductive hormone assays (LH, FSH, prolactin and day 21 progesterone),
ultrasound scanning and laparoscopy or hysterosalpingoraphy
(for diagnosis of tubal and uterine factors) were performed.
In some cases hysteroscopy and saline infusion ultrasonography
were also performed. The treatment was given according to the
cause of the infertility. However, the centre provided optimum
care and treatment which varied from the simple induction of
ovulation and sperm retrieval to intracytoplasmic sperm injection.
The study received ethical clearance from the Academy of Medical
Sciences and Technology.
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Results
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During the period of the study, 710 couples were investigated:
443 (62.4%) had primary infertility and 267 (37.6%) had secondary
infertility. The mean ± standard deviation (SD) duration
of infertility was 5.2 ± 4.3 years. Only 71 (10%) of
the couples presented before two years of infertility. The mean
± SD age of the female partner at presentation was 34.4
± 8.1 years.
Table 1 shows the relative male and female factors of the 710 investigated couples for the primary and secondary infertility. In 257 (36.2%) couples only the male factor was identified and in 350 (49.3%) infertility was due to female factors. There was no identified cause in 92 (13.0%) couples and infertility was due to male and female factors in 11 (1.5%).
Infertility in men was primarily due to Azoospermia (43, 16.8%),
oligzoospermia (45, 7.5%), asthenzoospermia (79, 30.7%) and
mixed pathology (90, 35.0%) (Table
2). Ovulatory factors
were the cause in 60.3% of the women: 20.9% were causes by tubal
blockage and 18.8% by uterine factors (endometrial fibroids,
polyps, congenital malformations and endometrial atrophy) (Table
3).
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Discussion
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This is the first published data on the pattern of infertility
in Sudan. The study showed that 62.4% of the couples had primary
infertility and 37.6% had secondary infertility. Among Tanzanian
couples, Infertility was primary in 37.1% and secondary in 62.9%.
5 In Nigeria, secondary infertility predominated (78.3%) according
to one report
4 and primary infertility in another.
7 In a report
from Ghana 40% of the couples suffered from primary and 60%
from secondary infertility.
6 Nevertheless, secondary infertility
tends to predominate in African countries.
2
Our study revealed that, in 257 (36.2%) infertility was due to male factor and 350 (49.3%) to female factors: there was no identified cause in 92 (13.0%) of the couples. In Tanzania, female-only factor infertility was identified in 65.9% of the couples, male-only factor infertility in 6.8%, male and female factors in 15.2% and unexplained factors in 12.1%.5 Olatunji and Sule-Odu reported that In Nigeria, the male factor was the only cause in 26.8%, the female factor in 51.8% and both male and female factors were contributory in 21.4%.4 Yet, Ikechebelu et al.7 reported a positive male-only factor in 133 (42.4%) and female-only in 81 (25.8%) couples in their report from Southern Nigeria. Idrisa and Ojiyi8 reported that in the Northern Nigeria the female infertility predominated. The male factor constituted 45% of infertility and tubal damage factor 23% of those diagnosed in a report from Ghana.6 In Mongolia 45.8% of couples suffered infertility due to a female factor and 25.6% due to a male factor: 9.8% of had no demonstrable cause: 18.8% had an infertility diagnosis in both partners.9 In our community, male infertility may be particularly problematic for men as both virility and fertility are seen as signs of manliness and male infertility is a potentially emasculating condition surrounded by secrecy and stigma.
In contrast to the previous reports from the central Sudan10 in this study, the ovulation failure was the most common cause for female infertility (60.3%) and the tubal occlusion was responsible for 20.9% of the female factor. Razzak et al.11 reported that ovulation disorders were the cause in 41% while tubal obstruction contributed to only 5% of cases of the female factor in Iraq. In South Africa, the most common causes of female infertility were ovulation disorders (41%) and, while tubal obstruction contributed to only 5% of cases, tubal factor infertility was overall the most common cause of infertility.12 In Nigeria, the most common female factor responsible for infertility was the tubal occlusion.12
This study carries an inherent biased factor as it was been carried out in a private centre among couples could afford the investigation. They might not be representative of the community. However, the study confirmed that there is a high proportion of secondary infertility and a relatively high proportion of female-only factors were involved.
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References
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- Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M. Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India. Fertil Steril 1997;68:637–43[Medline]
- Larsen U. Primary and secondary infertility in sub-Saharan Africa. Intern J Epidemiol 2000;23:285–91
- Cates W, Farley TM, Rowe PJ. Worldwide patterns of infertility: is Africa different? Lancet 1985;2:596–8[Medline]
- Olatunji AO, Sule-Odu AO. The pattern of infertility cases at a university hospital. West Afr Med J 2003;22:205–7
- Larsen U, Masenga G, Mlay J. Infertility in a community and clinic-based sample of couples in Moshi, Northern Tanzania. East Afr Med J 2006;83:10–17[Medline]
- Fiander A. Causes of infertility among 1000 patients in Ghana. Trop Doct 1990;20:137–8[Medline]
- Ikechebelu JI, Adinma JI, Orie EF, Ikegwuonu SO. High prevalence of male infertility in southeastern Nigeria. J Obstet Gynecol 2003;23:657–9
- Idrisa A, Ojiyi E. Pattern of infertility in North-Eastern Nigeria. Trop J Obstet Gynecol 2000;17:27–9
- Bayasgalan G, Naranbat D, Tsedmaa B. Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynecol Res 2004;30:386–93
- Mirghani OA, Babiker MY. Experience with gynaecological laparoscopies in Wad Medani Hospital, Sudan. East Afri Med J 1999;76:390–95
- Razzak AH, Wais SA. The infertile couple: a cohort study in Duhok, Iraq. East Mediterr Health J 2002;8:234–8[Medline]
- Stewart-Smythe GW, van Iddekinge B. Lessons learned from infertility investigations in the public sector. South Afr Med J 2003;93:141–3[Medline]
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SUMMARY
Introduction
