Worldwide patterns of infertility: is Africa different?

Abstract

The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples. The study was conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world. Over 5800 couples completed the investigation. African centres had a pattern of infertility different from those in other developing regions or the developed countries. African couples were more likely than those from elsewhere to have secondary infertility or longer duration, a history of sexually transmitted diseases or pregnancy complications, and infertility diagnoses (such as bilateral tubal occlusion or pelvic adhesions) suggestive of previous genital infections.

PIP: Analysis of data from a World Health Organization-sponsored collaborative investigation of infertility indicates that Africa may have a pattern of infertility quite different from that in other regions of the world. The study, which involved over 5800 couples that had been infertile for at least 1 year, was conducted in 33 medical centers in 25 countries throughout the developing world in 1979-84. African couples were more likely to have a wide age disparity between men and women, secondary infertility of longer duration, and a history of either sexually transmitted diseases (STD) or pregnancy complications. Africa was the only region where a majority of couples (52%) had secondary infertility; secondary infertility rate was 29% in developed countries evaluated and 16-40% in the other 3 regions of the developing world. Whereas 46% of couples in developed countries sought medical evaluation for infertility before waiting 2 1/2 years, over 2/3 in developing countries (70% in Africa) had been trying to conceive for more than 2 1/2 years. 9% of African women reported a history of STD compared to 3% in developed countries and 1% of those in the other 3 regions of the developing world. Pregnancy complications, largely due to infection, were reported by 8% of African women and 7% in Latin America but by only 2% in developed countries and in Asia and the East Mediterranean. The pattern of specific causes of infertility further differentiated Africa from the other regions. Over 85% of African women had diagnoses attributed to infection, most notably bilateral tubal occlusion and pelvic adhesions. The preponderance of infection-related causes of infertility in African couples suggests a need for public health programs to reduce these causes, including STD control and education programs.