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. 2020 Dec 2;6(1):20.
doi: 10.1186/s40738-020-00090-3.

Primary and secondary infertility in Africa: systematic review with meta-analysis

Melese Shenkut Abebe  1 , Mekbeb Afework  2 , Yeshiwas Abaynew  3
Affiliations

Primary and secondary infertility in Africa: systematic review with meta-analysis

Melese Shenkut Abebe et al. Fertil Res Pract. .

Abstract

Background: Infertility is a practical concern of Africans due to social disgrace and exclusion. This meta-analysis aims to analyze the proportion of primary and secondary infertility and identify the etiologic factors based on the studies conducted in Africa.

Methods: An internet-based search was conducted on the following databases; PubMed/Medline, EMBASE, Cochrane library, and google scholar. Both population and institution-based studies conducted among African couples, males, and females were included. Data extraction and critical appraisal of the articles were done by two independent investigators. Meta-analysis using a random effect model was conducted by Stata version 14. Forest plot, heterogeneity test, and funnel plot for publication bias were performed.

Results: The pooled proportion of primary and secondary infertility in Africa was 49.91% (I2 = 98.7, chi-square = 1509.01, degree of freedom = 19 and p < 0.001) and 49.79% (I2 = 98.7, chi-square = 1472.69, degree of freedom = 19 and p < 0.001) respectively. The pooled prevalence of the causes of infertility indicated that 54.01% and 22.26% of the infertility cases were respectively due to female and male-related problems. In 21.36% of infertility cases, both sexes were affected, while 10.4% of the causes of infertility were unexplained. The pooled prevalence of mostly reported causes of male infertility was 31% (oligospermia), 19.39% (asthenozoospermia), and 19.2% (varicocele). The most commonly identified causes of female infertility were pelvic inflammatory disease, tubal factors, and abortion with a pooled prevalence of 39.38%, 39.17%, and 36.41% respectively.

Conclusions: In Africa, the proportion of primary and secondary infertility is approximately equal. Infertility is mostly due to female-related causes like; pelvic inflammatory diseases, uterine tube related problems, and abortion. Oligospermia, asthenozoospermia, and varicocele were the commonest causes of male-related infertility. It is suggested that interpretation and utilization of these findings should consider the presence of substantial heterogeneity between the included studies.

Keywords: Africa; Meta-analysis; Primary infertility; Proportion; Secondary infertility.

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Conflict of interest statement

All authors declare that no competing of interest.

Figures

Fig. 1
Fig. 1
Prisma flow diagram showing screening and selection of studies for the systematic review and meta-analysis
Fig. 2
Fig. 2
Forest plot for the pooled proportion of primary infertility in Africa. ES: effect size (%) & CI: confidence interval
Fig. 3
Fig. 3
Forest plot of subgroup analysis for the pooled proportion of primary infertility in Africa. ES: effect size (%) & CI: confidence interval
Fig. 4
Fig. 4
Forest plot for the pooled proportion of secondary infertility in Africa. ES: effect size (%) & CI: confidence interval
Fig. 5
Fig. 5
Forest plot of subgroup analysis for the pooled proportion of secondary infertility in Africa. ES: effect size (%) & CI: confidence interval
Fig. 6
Fig. 6
Funnel plot for assessing publication bias in the proportion of primary and secondary infertility
See this image and copyright information in PMC

References

    1. Zegers HF, Adamson GD. International committee for monitoring assisted reproductive technology (ICMART) and the world health organization (WHO) revised glossary of ART terminology. Fertil Steril. 2009;92(5):1520–4. - PubMed
    1. Larsen U. Research on infertility: which definition should we use? Fertil Steril. 2005;83(4):846–52. - PubMed
    1. Cates W, Farley TM, Rowe PJ. Worldwide patterns of infertility: is Africa different? Lancet. 1985;326(8455):596–8. - PubMed
    1. Gerais A, Rushwan H. Infertility in Africa. Popul Sci. 1992;12:25. - PubMed
    1. Chigumadzi P, Moodley J, Bagratee J. Infertility profile at King Edward VIII Hospital, Durban, South Africa. Trop Doct. 1998;28(3):168–72. - PubMed

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