Case records and commentaries

Abstract

Background: Infertility is a complex disorder with significant medical, psychosocial, and economic aspects. Both the prevalence of infertility and the number of patients seeking treatment of this disorder are increasing. Objectives: The aim was to evaluate the services that were offered to infertile couples seeking medical attention in Nazareth Mission Hospital. Methodology: This was a retrospective study in which the services that were accorded to the subjects who attended the infertility clinic in Nazareth Hospital between 15t January 1999 and 315t December 2004 were evaluated. The data was collected using a questionnaire, coded, validated and analysed using SPSS version 12.0 statistical package. Results: The services rendered to 298 subjects were evaluated. The services offered were diagnosis making by thorough history taking and specific investigations, definitive interventions/treatment and referral of clients accordingly. There were 129(43.3%) who had primary infertility and 169(56.7%) with secondary type from history taking. Specific services undertaken included tubal patency tests in 159(53.4%), pelvic ultrasonography in 69(23.2%), hormonal profile 38(12.8%) and semen analysis of the male partner in 99(33.2%) of the clients. Female causes of infertility were found to be tubal factors in 76(25.6%), hormonal disorders 20(6.7%) and uterine abnomalities 23(7.7%). Abnormal semen analysis was reported In 42(14.9%) of the male partners. The interventions/treatment offered included ovulation induction with clomiphene ± metformin in 90(30.2%), corrective surgery in 19(6.4%), treatment of pelvic inflammatory disease in 23(7.7%) and hormonal regulation of menses in 9(3%). There were 5(1.7%) cases referred for In Vitro Fertilization. The interventions were successful in 27 (9.1%) who conceived but only 23 (7.7%) were referred to the ANC as 2 (0.7%) cases ended up in abortion and the other 2 (0.7%) had ectopic pregnancy. The other 61 (20.5%) were unsuccessful despite investigations and interventions. About 205 (68.8%) were lost to follow up Conclusion: The services offered were just satisfactory in management of female infertility but inadequate for male infertility or in cases where immunological incompatibility is the cause of infertility in a couple.