Causes and types of infertility amongst couples managed at Kenyatta National Hospital

Abstract

Background Infertility affects a relatively large number of couples (about 50 -80 million) worldwide with an estimated global prevalence of 8-12% but higher in Africa 20-30%. The magnitude of infertility in Kenya remains inadequately determined, however, a National infertility survey established that Infertility cases in Kenya comprises approximately 30% of all gynecological consultations at national referral hospitals,15% in district hospitals,4% in health centers and 2% in dispensaries in Kenya. The causes of infertility vary among populations and are dynamic. This study describes the current causes and types of infertility amongst infertile couples attending Kenyatta National Teaching and Referral Hospital (KNH). It forms a base line for the local infertility situation and basis for further scientific research on infertility. Broad Objective To determine the causes and types of infertility amongst infertile couples being managed at KNH in 2012. Methodology A hospital based descriptive study was done in KNH Infertility Clinic and Gynecological Outpatient Clinics between February and September 2012 .Recruitment was consecutive till a sample size of 79 was reached. A structured questionnaire was administered to capture key socio-demographic and reproductive health characteristics. The Investigation results and diagnosis were extracted from patients’ records and entered into an SPSS Info data base, cleaned, and analyzed using SPSS (v.17) and STATA (v.11). Results Among infertile couples, the mean age of females was 30.5(SD 5.9) years while that of males was 36.5 (SD 7.8) years. This study found 41.8% of infertility to be due to female factor only, 16.5% male factor only, 35.4% combined male female factor and 6.3% due to unexplained causes. Majority of the infertile females had primary infertility (55.6%) compared to secondary infertility 44.3%.The commonest cause of female factor infertility was tubal factor 83.6% with a majority having bilateral blocked tubes (60.6%).Abnormal sperm characteristics were in about 52% of male partners in which 7.6% had azoospermia and 14.6% erectile dysfunction. Conclusion This study showed that the gender distribution of infertility causes is similar to earlier studies with exception of combined male and female factor infertility which was higher in this study. In addition, the mean age of infertile female was found to be higher than earlier studies. It also showed a high rate of tubal factor infertility and male factor infertility. Slightly more than half of the male partners had abnormal sperm characteristics with a significant proportion azoospermic, sexual dysfunction among male partners occurred in 15%. Recommendations 1. To establish facilities in Kenyatta National Hospital capable of management of male infertility due to the high male factor infertility. 2. Strengthening of public health education on safe sex practices to prevent acquisition and transmission of sexually transmitted illnesses.