Prospective evaluation of causes of infertility at a tertiary care hospital

Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Worldwide, its prevalence is approximately 8-12%. There are numerous factors such as anatomical, physiological, genetic, environmental and acquired factors that cause infertility. The aim of the present study was to determine the causes and clinical pattern of infertility in infertile couples in North West India.

It was a hospital based observational study carried out on 211 infertile couples in reproductive age group attending infertility clinic of Sardar Patel Medical College and associated PBM Hospital, Bikaner, Rajasthan between September 2016-February 2017. Collection of data was performed by means of a specifically designed questionnaire, which apart from the demographic data also included questions concerning the causes of infertility. Cases of infertility diagnosed after detailed history, clinical examinations and laboratory tests were included.

Out of 211 infertile couples, female factor was predominant in 60.18%, male factor in 15.16%, unexplained in 15.16% while a combination of both factors was seen in 9.47% cases in our study. 33.17% women had ovulatory dysfunction diagnosed by menstrual history and ultrasonography. Tubal block was observed in 9.47% infertile women. 6.63% women had hypothyroidism and 1.89% infertile women were diagnosed to have endometriosis. Husband semen analysis was also done to assess male factor. Nearly 5.21% of their male partners suffered from oligospermia, 4.73% had azoospermia and oligoasthenospermia was observed in 3.79% male partners.

Predominant cause of infertility can be reported in male or female partner or both so, either partner should be counselled and investigated properly. Our study reports a predominance of female factors as a cause of female infertility but male factors also accounted for a significant number of cases.Metrics

Kumar D. Prevalence of female infertility and its socio-economic factors in tribal communities of central India. Rural and Remote Health, 2007. Available at: http://www.rrh.org.au. World Health Organization. In fecundity, infertility, and childlessness in developing countries. DHS Comparative Reports No. 9. Calverton, Maryland, USA: ORC Macro and the World Health Organization;2004. Available at: http://www.who.int/reproductivehealth/topics/infertility/DHS-CR9.pdf. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care. Hum Reprod. 2007;22:1506-12. Jejeebhoy SJ. Infertility in India-levels, patterns and consequences: Priorities for social science research. J Fam Welf. 1998;44:15-24. Daar A, Merali Z. Infertility and social suffering: the case of art in developing countries. Geneva, Switzerland: World Health Organization;2001:16-21. Campbell AJ, Irvine DS. Male infertility and intracytoplasmic sperm injection (ICSI). Br Med Bull. 2000;56:616-29. Adamson PC, Krupp K, Freeman AH, Klausner JD, Reingold AL, Madhivanan P, et al. Prevalence and correlates of primary infertility among young women in Mysore, India. Indian J Med Res, 2011;134:440-6. Chowdhary MA, Haque MM, Choudhary S,Prodhania MS. Determinants of infertility among couples seeking treatment in a selected clinic in Dhaka city. Chattagsam Maa-O-Shishu Hospital Med College J. 2014;13(3):42-5. Panti AA, Sununu YT. The profile of infertility in a teaching Hospital in North West Nigeria. Sahel Med J. 2014;17(1):7-11. Bayasgalan G, Naranbat D, Tsedmaa B, Tsogmaa B, Sukhee D, Amarjargal O, et al. Clinical patterns and major causes of infertility in Mongolia. J Obs Gynaecol Res. 2004 Oct;30(5):386-93. Masoumi SZ, Parsa P, Darvish N, Mokhtari S, Yavangi M, Roshanaei G. An epidemiologic survey on the causes of infertility in patients referred to infertility center in Fatemieh Hospital in Hamadan. Iran J Reprod Med. 2015;13(8):513-6. Karimpour A, Esmaeelnezhad Moghadam A, Moslemizadeh N, Mousanezhad N, Peyvandi S, Gahandar M. Incidence and main causes of infertility in patients attending the infertility center of Imam khomeini hospital in 2002-2004. J Mazandaran Univ Med Sci. 2005;15:44-9. Tomassetti C, Meuleman C, Pexsters A, Mihalyi A, Kyama C, Simsa P, D'Hooghe TM. Endometriosis, recurrent miscarriage and implantation failure: is there an immunological link? Reproductive BioMedicine Online. 2006;13(1):58-64. Sudha G, Reddy KS. Causes of female infertility: A crosssectional study. Inter J Latest Res Sci Tech. 2013;2(6):119-23. Gohill BC, Rosenblum LA, Coplan JD, Kral JG. Hypothalamicpituitary-adrenal axis function and the metabolic syndrome X of obesity. CNS Spec. 2001;6(7):581-6. Aubuchon M, Burney RO, Schust DJ, Yao MWM. In: Infertility and Assisted Reproductive Technology. 15th ed. Berek JS, editor. Lippincott Williams and Wilkins, a Wolters KLuwer business;2012. Rao MM, Dora MR. Cytogenetic studies in primary infertility. Fer Ster. 1977 Feb 1;28(2):209-10. Grange JM, Donald PR, Pai M. Tuberculosis a comprehensive clinical reference. USA: Saunders Elsevier;2009:457-462. Ghahremanei F, Ghaem H. The effective factors on men infertility: a case-control study. J Gorgan Uni Med Sci. 2005;7:42-5. Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. IMAJ. 2011;13:51-4.