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PART 2 CHAPTER X
2.10.1.
The Prevalence The results of the present nation-wide survey in women show that the prevalence rate of infertility is quite high. The prevalence rate of total infertility, including sub-fertility, is 31.9% in this sample. The rate of the primary infertility (including sub-fertility) is 3.4% and of secondary infertility is 28.5% (Figure 2.10.1.). Figure 2.10.2. demonstrates the percentage distribution of respondents, according to all fertility sub-categories. Forty-one women (2.9%) were classified as primarily infertile since they never had been pregnant despite cohabitation and exposure to the risk of pregnancy for a period of 2 or more years. Six women (0.5%), who had never been pregnant for more than 1 year, but less than 2 years of unprotected sexual intercourse, were defined as primarily sub-fertile. Three hundred and fifty-one women (25.1%) were secondarily infertile and forty-nine (3.4%) were secondarily sub-fertile. Fertility category of 12 women (0.9%) was uncertain.
The
great majority of 47 primarily sub-fertile or infertile women (85%) were
trying to have offspring without success despite cohabitation for a
period of at least one year. In fact, 288 (72%) out of 400 secondarily
sub-fertile or infertile women did not want to have (another) child in
the near future.
2.10.2.
Gender-related Causes
Beliefs
of respondents about gender-related causes of infertility:
The great majority of women (92%) were aware that infertility is not exclusively a female problem, but still about 8% of them had contrary ideas or no idea about this issue (Figure 2.10.3.).
Is
infertility exclusively a female problem? Most of the survey respondents were sure that they are able to become pregnant; however, 13% of women had contrary beliefs and about 15% were not sure (Figure 2.10.4.).
Can
you become pregnant? The most important reasons for the contrary beliefs or lack of confidence of 391 women about their own fertility are shown in the Table 2.10.1. More than 6% of women with impaired fertility supposed that the causes of infertility are related exclusively to their partners. About 68% believed that the causes of infertility are related only to their own sexual health problems and almost 9% had an opinion that the causes are in both partners (Figure 2.10.5.).
2.10.3.
Diagnosed Causes
Gender-related
diagnosed causes: In about 55% of 128 investigated couples the causes of infertility were found only in female partners and in 29% they were found in both partners (Figure 2.10.6.). In total, the causes of female infertility were diagnosed in about 84% of couples, and of male infertility in 35%. In more than 10% of the cases the causes of infertility remained unknown.
Specific
causes of female infertility: The most frequent diagnosed causes of infertility in females, as reported by the respondents, are shown in Table 2.10.2.
Thus,
about 45% of women mentioned that they have had acquired ovarian
abnormalities, which is higher than might be expected, as compared to
the results of our clinical-based previous investigations of infertile
couples, using the standardized WHO methodological approach.
Perhaps, the most significant contribution is coming from the over
diagnosis of the chronic inflammatory diseases of the ovaries and/or of
the Polycistic Ovaries Syndrome. Among other frequent causes of
infertility in female partners are mentioned: menstrual or ovulatory
disorders (36.5%), acquired uterine or cervical abnormalities (36.5%),
and tubal occlusion including adhesions (35.5%).
Specific
causes of male infertility: According to the women’s replies 73 men with impaired fertility sought out medical investigation, but only in 59 of them (81%) semen analysis was performed. The most frequently diagnosed causes of the male infertility known by 59 women (Table 2.10.3.) were abnormal quality or the quantity of sperm (36%), sexual dysfunction (8.5), and male accessory gland infection (5%). In fact results of our previous (1985) clinical investigations of infertile couples, based on the standardized WHO methodological approach (2) shows that male accessories gland infection was diagnosed at that time in about 2.5% of infertile men.
2.10.4.
Background Factors
Available
research data show that some environmental factors, such as cigarette
use, excessive alcohol consumption, and drug abuse decrease fertility
(3). This study found that a proportion of female smokers was
significantly higher than of non-smokers (p<0.00) among women with
the primary infertility or sub-fertility (6.3% versus 3.2%) and with the
secondary one (38% versus 28%). In fact, the proportion of female
smokers among fertile and presumably fertile women was lower than of
non-smokers (56% versus 68%, p<0.00).
The
proportion of women who ever excessively used alcohol beverages was
significantly higher than of non-users among women with secondary
infertility or sub-fertility (44% versus 27%, p<0.00). The similar
observation was found among male partners of women with secondary
infertility or sub-fertility (57% users and 28% non-users, p<0.00).
The
proportion of women who occasionally used narcotic drugs was almost
twice higher than of non-users among women with the primary infertility
or sub-fertility (6.3% versus 3.2%). It was higher and among women with
secondary infertility or sub-fertility (38% versus 28%, p<0.00).
A strong relationship was found between a history of certain STDs and Infertility. The history of Gonorrhea, Syphilis, Chlamydial infection, and Trichomoniazis was more common in women with impaired fertility, as compared to fertile (Table 2.10.4.). For many couples infertility is a cause for the long-term psychological stress. Figure 2.10.7. demonstrates psychological conditions of the infertile couples who are willing to have a child. In some families infertility is disturbing interpersonal family relationships. Table 2.10.5. shows family relationship of 128 women with impaired fertility who sought out medical investigation.
2.10.5.
Access to Medical Care In only 128 out of 447 cases (29%) with impaired fertility had at least one partner sought out medical investigation. In most of the infertility cases neither partner was investigated (Figure 2.10.8.). Investigation of male partners was carried out only in 16% of couples who attended health facility for medical care. Almost 41% of infertile women did not apply for medical care because they completed their family formation and 27% preferred to wait until spontaneous conception. In about 15% of the cases husbands or relatives objected to medical investigation, and 8% had no mean to cover the expenses for infertility care (Table 2.10.6.). Most of couples with impaired fertility applied for infertility investigation and care to a specialized health center or district maternity/hospital. However, some went to facilities that are not specialized for the investigation and diagnosis of infertile couples (Table 2.10.7.). A total of 93 out of 128 woman (73%) seeking infertility care received medical treatment. However, only 15 male partners (12%) have been treated (Figure 2.10.9.). In 36 (28%) out of 128 women who applied for infertility care, genito-urinary surgery was performed. Twelve women had diagnostic laparoscopy (9.4%). For a significant number of infertile couples (62%), investigation and treatment was rather complicated or unaffordable (Figure 2.10.10.). This survey found that approximately 39% of infertile couples had financial difficulties in getting health care, about 11% had difficulties in finding prescribed medicine, and 9% complained that the health facility is far away from their home. Among the startling observations of this survey was the fact that about 2% of women had an opinion that health providers lack counseling and clinical skills for infertility management. |