The social and cultural consequences of infertility in rural and periurban

Relatively little is known about infertility experiences among women in rural Malawi and the impact of infertility on women's marital and family relations. This article examines the perspectives of women and health care providers regarding women's concepts of reproductive health and attitudes toward infertility. The paper explores the supports and barriers to managing infertility at the individual, household, and community levels. The data presented was drawn from semi-structured interviews with health care providers and patients within a prevention of mother to child transmission program and focus group discussions with community men and women in four communities in Southern Malawi. Seventy-eight patients, 12 health care providers, and 32 community leaders participated in the study. The findings suggest that gender inequities and kinship relations intersect to produce infertility related stigma which exacerbates the social and cultural consequences of being infertile in these study communities. Social support from other women experiencing infertility is one strategy to help women manage the social and cultural burden of infertility in these study communities. These results shed light on the meaning of motherhood to women living in rural and periurban Sub-Saharan African communities and call for an expansion of infertility services, social services, and mental health services for both women and men who experience infertility. (Afr J Reprod Health 2022; 26[7]: 112-126).

Herbalists' explanations of infertility: The case of Northern and Southern Ghana

In sub-Saharan Africa, traditional medical practitioners also referred to as herbalists, offer diagnostics and therapeutics for diverse medical conditions irrespective of the cause. Given their traditional role as healers and repository of knowledge about medicinal plants, spirituality, customs and religion, people use their services regardless of their location, education, or socio-economic backgrounds. The aim of the study is to explore herbalists´ views and explanations on infertility and women with infertility. Using an exploratory qualitative design, semi-structured interviews were conducted with 10 herbalists, 5 from the North-East region, 2 from Ashanti region and 3 from the Greater Accra region. Following thematic analysis, findings show that infertility has multiple causes - medical, natural, spiritual and lifestyle. Some herbalists stated that everyone was created to bear children while others refuted this notion. They shared the common consensus that not everyone can have children even though they may be medically and spiritually fit. The public should be advised on the need for periodic reproductive health checks. Also, there should be a conscious, concerted efforts to gradually dissociate unhealthy explanations of infertility from the actual empirically proven realities.This would empower society to rise above those entrenched beliefs, thereby reducing the stigma associated with infertility and women with infertility. (Afr J Reprod Health 2022; 26[5]: 96-106).

Relationship between hormonal profile and therapeutic testicular biopsy/ tese findings in azoospermic men

Background. Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.Objective. To determine the efficacy of the SSC using data from randomised controlled trials (RCTs).Methods. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.Results. Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital, with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection, attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64, 95% CI 0.57 - 0.71; p<0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59, 95% CI 0.21 - 1.70; p=0.33, cardiac complications RR 0.74, 95% CI 0.28 - 1.95; p=0.54, infectious complications RR 0.61, 95% CI 0.29 - 1.27; p=0.18, and perioperative bleeding RR 0.36, 95% CI 0.23 - 0.56; p<0.00001.Conclusions. There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent

Infertility in Gabon: a survey to determine diagnostic and medical support to patients

A survey among gynaecologists practising in Libreville was conducted to ascertain the level of infertility assistance available, and the feasibility of establishing an intrauterine insemination programme in Gabon. This descriptive study invited gynaecologists (n=20) in both private and public hospitals, who are members at the Gabonese Society of Obstetricians Gynaecologists and Reproduction, to participate in the survey. Seventeen (85%) surveys were completed. The information obtained indicated that each gynaecologist consulted with more than fifty patients monthly, and nearly half (45%) of these consultations were infertility related. Male patients were referred to four different pathology laboratories in Libreville for basic semen analyses (without microbiology testing). Nearly 65% of the respondents referred female patients for further infertility treatments elsewhere. Approximately one-third of all couples were unable to access additional medical assistance. This survey can be viewed as motivation for health policymakers to initiate discussions to improve medical diagnostics and implement accessible fertility services in Gabon. Gynaecological expertise, together with a developed infrastructure in Libreville, could serve as an appropriate base for the advancement of reproductive treatment facilities

Seroprevalence of microbial organisms during routine infertility evaluation at University of Benin Teaching Hospital, Benin-City, Nigeria

Background: The association of genital microorganism with infertility has been documented but no consensus exists. Understanding their prevalence amongst infertile clients may assist in facilitating better screening protocols. The objective of this study is to determine the prevalence of microorganisms routinely screened among women undergoing infertility evaluation at the University of Benin Teaching Hospital. Methods: A three year (January 2015 to December 2017) retrospective survey of all patients evaluated for infertility at the assisted reproduction unit of the hospital was undertaken. Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, cytomegalovirus (CMV), hepatitis B (HBV), hepatitis C (HCV) virus and the human immunodeficiency virus (HIV) were microorganisms serologically assayed at the unit. We analyzed data containing patients' demography and results of serological assay of these microorganisms. Results: There were 576 patients (288 couples) who completed their microbiological evaluation during the study period. The mean age (years) of female partners was 38.2±5.7, while the mean age of the male partners was 42.7±6.1. The frequency of CMV positive assay for infertile couples was 129 (22.4%); C. trachomatis 125 (21.7%); M. hominis 92 (15.9%) and U. urealyticum 76 (13.2%). Overall, more women (50.7%) were seropositive compared to men (26%). HIV was positive in 10 patients (1.73%) with 60% being women. HBV was seropositive in 8 (1.4%) (women 62.5% and men 37.5%) while HCV was positive in only 2 (0.3%) patient. Majority (over 80%) of couples were sero-discordant with 20% (2) concordance rate for HIV and 12.5% (1) for hepatitis B. Conclusion: Despite a relatively high seroprevalence rate of the studied microorganisms, the documented uncertainty on their association with infertility or its treatment limits justification for incorporation of routine screening of microbiological organisms into standard protocols for evaluation of infertile couples. A robust study on the impact of genital microorganism on specific infertility variables with comparison to fertile controls is recommended

Morphologic patterns of testicular lesions in Uyo: A university hospital experience

Background: The testis can be biopsied either for a diagnostic or therapeutic purpose. Objective: The aim of this study is to characterize the common indications for testicular biopsy and determine the pattern of testicular lesions. Materials and Methods: This was an 8­year retrospective study of all testicular and paratesticular specimens that were histologically diagnosed in the Department of Histopathology in University of Uyo Teaching Hospital between January 2008 and December 2015. Results: Sixty­four cases of testicular specimens were received in the histopathology laboratory, accounting for 1.3% of all received specimens. The youngest patient was 4 years, while the oldest patient was 86 years with a mean age of 54.4 ± 21.62. The most common presenting complaints seen in the nonfertility, nonprostate cancer­related cases were testicular swelling, pain, and small­sized testis as seen in 50%, 31.3%,and 12.5% of cases, respectively. In 60.9% of cases, the clinical diagnosis was prostatic cancer, while primary and secondary infertility accounted for 12.5% and 1.6%, respectively, with testicular/paratesticular tumor been the clinical diagnosis in 7.8% of cases. The mean ages for surgical castration patients, male infertility patients, and malignant lesion patients were 68.9, 41.7, and 46.5 years,respectively. Hypospermatogenesis was the most common histopathologic diagnosis of testicular biopsies in infertile men (33.4%). Four malignant lesions were seen, with embryonal rhabdomyosarcoma accounting for 50% of cases. Conclusion: Benign neoplastic lesions of the testis are very rare in study population, while embryonal rhabdomyosarcoma is the most common malignant lesion seen. Most men do not present to health facility for infertility management

Prevalence of chlamydia trachomatis infection in infertile women attending fertility clinics in Benin city, Nigeria: a public health concern

This study was carried out to deduce the prevalence of Chlamydia infection amongst infertile women attending fertility clinics in Benin City, Nigeria. Fifty infertile women with either primary or secondary infertility and with their ages ranging from 24 to 51 years were enrolled for this study. The serum of each patient was screened for Chlamydia antibodies with the enzyme-linked immune-sorbent assay (ELISA) and immunoglobulin G (IgG) index of 0.90 or less was reported as seronegative for IgG antibody, while IgG index of 1.00 or greater were positive for IgG antibody. Findings in the present study revealed that 24 % to 52 % of the patients that attend the fertility clinics in Benin City, Nigeria were most likely to be infected with Chlamydia; with the primary infertile patients accounting for 32 % of the cases and secondary infertile patients for 68 % of the cases. Prevalence of Chlamydia infection was also found to be quite high amongst women aged between 36 and 40 years old. Since lack of symptoms often makes the clinical diagnosis of Chlamydia infection somewhat difficult, thus increasing the prevalence of this disease; routine screening is recommended to enable early therapeutic interventions of positive cases

Prévalence et profil des coules pris en charge pour infertilité du couple à l'Hôpital de la Mère et de l'enfant de N'Djamena

Introduction: L'infertilité est une pathologie fréquente dans les pays en développement et pose un problème de prise en charge. L'objectif était de déterminer sa prévalence et le profil des couples consultant pour infertilité dans de la Mère et de l'enfant de N'Djamena. Méthodologie:Nous avons mené une étude transversaledescriptive portant les couples ayant consulté pour infertilitédu 1er Décembre 2014 au 30 Novembre 2015. Tous les couples vus pour infertilité ayant effectué tous les bilans et ayant accepté de participer à l'étude après un consentement éclairéont été inclus. Résultats: La prévalence de l'infertilité était de 14%. Cette infertilité était de prédominance secondaire(61%). La majorité des couples dans cette série avait une infertilité d'une durée d'un à trois ans (67,9%). Les tranches d'âges les plus touchées étaient celles de 30 à 34 ans avec un âge moyen de 28,9 ans ± 6,1 chez les femmes et de 40 ans et plus et 30 à 34 ans et 25-29 ans avec un âge moyen de 34,1 ans ± 6,7 chez les hommes. Le statut matrimonial était dominé parles monogames (60,7%). L'infertilité était féminine dans 42% des cas, masculine dans 30% des cas et mixte dans 28% des cas. Les anomalies de spermogramme étaient présentes chez 50% des couples, les infections dans 48,2%, les troubles hormonaux dans 39,3% et les obstructions tubaires dans 23,2%. Conclusion: L'infertilitéest un réel problème dans nos milieux dont la responsabilité incombe également aux 2 sexes. Cela devrait être pris en compte dans la prise en charge

Aspects epidemiologiques et etiologiques des couples infertiles a Abidjan

Objectif : Ce travail avait pour objectifs d'identifier les caracteristiques sociodemographiques des couples infertiles et de preciser les principales etiologies. Methode : Nous avons mene une etude retrospective descriptive portant sur 210 couples consultant pour infertilite dans les services de gynecologie du CHU de Treichville et d'une clinique privee de la place durant la periode 1er fevrier 2013 au 30 septembre 2014 (20 mois). Resultats. La prevalence de l'infertilite etait de 14;03%. L'age moyen etait de 34;31 ans chez les femmes et de 43;2 ans chez les hommes. La majorite des patientes avait atteint au moins le niveau d'etude secondaire (77;1%). Les couples residant hors d'Abidjan etaient de 15%; et les differentes couches socio-economiques etaient touchees par l'infertilite. La duree moyenne de vie commune des couples etait de 6;9 ans avec une duree moyenne d'infertilite de 6;3 ans. L'infertilite etait en general de type secondaire; touchant aussi bien les femmes (41%) que les hommes (30%). Les etiologies chez les femmes etaient d'origine uterine (47;06%); hormonale (22;79%) et tubo peritoneale (17;65%). Chez l'homme les troubles du sperme etaient domines par l'oligoasthenospermie (69;91%) d'etiologie generalement infectieuse. Conclusion. l'infertilite etait frequente dans nos services; touchant aussi bien les femmes que les hommes

Bilan d'activite coelioscopique dans un hopital secondaire. cas de l'hopital general d'Ayame (Cote d'Ivoire)

Objectif. Etablir le bilan de l'activite colioscopique a l'Hopital General d'Ayame Methode. Il s'agissait d'une etude retrospective et descriptive qui s'etait realisee a l'hopital general d'Ayame et qui concernait tous les actes coelioscopiques effectues dans le service de gynecologie et d'obstetrique du 02 janvier 2013 au 30 juin 2014. Nous avions etudie les caracteristiques socio-demographiques des patientes; les indications; les actes operatoires (diagnostiques et therapeutiques) et la morbidite postoperatoire. Resultats. Il a ete realise 45 interventions percoelioscopiques; soit 21% de l'activite chirurgicale gynecologique de l'hopital. Les patientes avaient un age moyen de 33;1 ans avec des extremes de 24 et 44 ans. Il s'agissait en majorite de nulligestes et primigestes (66%); de nullipares (71%); de cadres et de niveau scolaire superieur (48;8%); residant a Abidjan (66;6%) et vivant maritalement (75%). L'infertilite et la seconde consultation post-myomectomie etaient les indications avec respectivement 67% (30 cas) et 33% (15 cas). Les constatations per operatoires pour infertilite etaient dominees par les adherences periannexielles; les kystes ovariens et les obstructions tubaires avec des frequences respectives de 33%; 27% et 23%. L'adhesiolyse et la kystectomie representaient les actes chirurgicaux les plus realises dans des proportions respectives de 53;3% (24 cas) et 13;3% (6 cas). Dans tous les cas de seconde consultation postmyomectomie; nous avions note des adherences parmi lesquelles predominaient les type II (60%). Aucune complication operatoire n'avait ete observee. Conclusion : la colioscopie est realisable en dehors des structures sanitaires de niveau tertiaire. Une mise a niveau du personnel pourrait ameliorer sa pratique

Perception of Women of Childbearing Age (15-45 years) on Causes and Consequences of Infertility in Osogbo Local Government Area of Osun State; Nigeria

Infertility brings about low self-esteem; sense of powerlessness; discrimination and stigmatization as well as threatens the woman's identity; status; marital and emotional security. This study examined the perception of women of childbearing age on causes and consequences of infertility. A descriptive non experimental research design was used. A sample frame of 40 respondents was selected inferential statistics. Three null hypotheses were tested using student t-test at 5level of significance. The study revealed that irregular sexual intercourse; irregular menstruation; untreated sexually transmitted diseases; late marriage especially above 30years of age; fibroid; low sperm count; unsafe abortion; and promiscuity were factors contribute immensely to increase infertility rate. Majority of the respondents opined that infertility could result in divorce or separation of couple which can lead to extinction of that family name; husband's family inherit his property after his death; polygamy or polyandry; loss of hope; lack of joy and happiness in the family. The findings of this study revealed that there is no significant difference in the age religion of women under study and their perception on causes and consequences of infertility with t-calculatedt-tabulated (2.54 4.3); as well as; there is no significant difference was found between the age at marriage of women under study and their perception on causes and consequences of infertility with t-calculatedt-tabulated (2.56 4.3). The results also revealed that there is significant difference in the religion of women under study and their perception on causes and consequences of infertility with t-calculatedt-tabulated (7.64 4.3). It was concluded that sound family life education should be given to the public especially women and adolescents teenagers with emphasizes on causes; prevention and management of infertility

Sterility and stigma in an era of HIV/AIDS: narratives of risk assessment among men and women in Botswana

This paper examines the experience and interpretations of infertility and sterility in northern Botswana. Specifically it highlights the role of stigma and impression management among Tswana men and women through their narratives and discourse about childbearing and personhood in an era of HIV/AIDS. The paper demonstrates that in a country with one of the highest HIV/AIDS infection rates in the world, risky sexual practices are weighed against cultural norms that suggest being a full person and productive adult is to be a reproductive man or woman. Through longitudinal qualitative research the narratives and life histories of several individuals offer ethnographic evidence on the power of stigma. The research finds that even with ubiquitous HIV/AIDS education and prevention programmes throughout Botswana, Tswana engage in various kinds of risk taking behaviours as means through which impressions and identities as full persons of value may be managed successfully (Afr J Reprod Health 2011; 15[1]: 95-100)

Laparoscopic Myomectomy for Infertile Patients with Intramural Fibroids: a Retrospective Study at a Tertiary Endoscopic Centre

Background: The safety of laparoscopic myomectomy has been questioned especially in the case of intramural fibroids. Objectives: To assess the safety of a laparoscopic myomectomy for intramural fibroids and study the subsequent effect on fertility Methods and Settings: A retrospective study of a tertiary endoscopic centre specialising in laparoscopic myomectomy. Results: 87 Patients were studied and there were no major complications. The conversion rate from laparoscopy to laparotomy was 3/87 (3.4) due to multiple fibroids. There was one case of uterine perforation during hysteroscopy. The overall pregnancy rate was 29/64 (45) with a spontaneous pregnancy rate of 18/29 (62). Conclusions: Laparoscopic myomectomy can be regarded as a safe alternative to abdominal myomectomy in the hands of the experienced surgeon resulting in good subsequent pregnancy rates

Cultural and ethical challenges of assisted reproductive technologies in the management of infertility among the yoruba of southwestern Nigeria

This paper discusses the cultural and ethical issues arising from the use of Assisted Reproductive Health Technologies. Twenty-five In-depth interviews were conducted with 5 couples of reproductive age who have never conceived or brought pregnancy to term after one year of unprotected intercourse, 4 adult males, 4 adult females, a gyneacologist, a nurse, a herbalist and 2 religious leaders in Ibadan, Nigeria. Content analysis was used for data analysis. Legitimacy of children born through ART, religious obligation, patriarchy, polygamy and value of children are cultural issues surrounding ARTs while decision making about it, discrimination against children born through ART, psychological problems and loss of self esteem, side effects of the technologies and the cost of accessing them are the ethical challenges. The findings have methodological implications for conducting infertility research in non-western societies. (Afr. J. Reprod. Health 2010; 14[2]: 115-127)

Sterilite du couple a l'Institut Medical Chretien du Kasai

Introduction : Une etude transversale a ete menee de janvier 2004 a decembre 2007 a l'Institut Medical Chretien du Kasai. Objectifs : Definir le profil socioepidemiologique de la femme ayant consulte a l'Institut Medical Chretien du Kasai pour sterilite et determiner a partir des examens paracliniques simples la responsabilite de chaque conjoint et la cause de la sterilite. Resultats : 11des femmes ont consulte pour une notion de sterilite de minimum 2 ans. La moitie des sujets (50;8) est agee de moins de 35 ans; avec une moyenne d'age de 28 +/-3 ans. La sterilite feminine secondaire etait predominante (70;2) et la responsabilite mutuelle de l'homme et de la femme dans la sterilite a ete retrouvee dans 33des cas. Considere individuellement; l'homme est apparu avoir plus de responsabilite que la femme (34;6vs 21;4). Les femmes provenant du milieu urbain etaient majoritaires (62;1). Un niveau d'instruction ne depassant pas le cap de l'ecole secondaire apparaissait aussi comme un facteur frequemment associe a la sterilite (89.6). Les causes mecaniques ont ete plus frequentes que les causes fonctionnelles (81;2vs 18;8). L'oligo-asthenospermie a ete la cause gonadique masculine la plus importante dans notre serie (56;2). Conclusion : La sterilite du couple est un probleme de sante publique dans nos milieux a cause de sa frequence et de ses repercussions sociales. La prevention des infections sexuellement transmissibles pourrait concourir a contourner ce fleau

Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria

Objective: To determine the psychosocial and clinical factors that are associated with psychiatric morbidity among women with infertility attending a Nigerian gynaecology clinic. Method: Over a four month period, 320 respondents (160 in the study group and 160 in the control group) were interviewed using a proforma (designed by the authors) and a screening instrument, General Health Questionnaire version 30 (GHQ-30). All probable cases with a score of 5 or more on GHQ-30 were interviewed using the Present State Examination (PSE). Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10). Results: The infertility rate among the study group was found to be 25.8% with primary and secondary infertility rates constituting 21.9% and 78.1% respectively. The prevalence of psychiatric morbidity among women with infertility (48.8%) was significantly more than that in the control group (11.2%) (c2 = 51.80, p < 0.0001). Lack of support from husband (c2 = 15.31, p < 0.001), lack of support from husband's relatives (c2 = 39.60, p < 0.0001), discrimination (c2 = 69.91, p < 0.0001) and history of induced abortion (c2 = 30.40, p < 0.0001) were found to be significantly associated with psychiatric morbidity among patients with infertility when compared with the fertile control population. There was no significant difference in the rate of psychiatric morbidity between women with primary infertility and those with secondary infertility (c2 =0.03; p = 0.87). Conclusion: Psychiatric morbidity is significantly more common among patients with infertility as compared with those without. There was a significant association between psychiatric morbidity and absence of support from husband and his relations, presence of discrimination, and a history of induced abortion. We suggest more public enlightenment on the need for moral/ psychosocial support to women with infertility. In addition, more efforts should be made towards early screening and identification of cases of psychiatric morbidity among patients with infertility

Testicular Biopsies of Azoospermic Men at The Lagos State University Teaching Hospital

Objectives: This study was conducted to evaluate the histological findings from testicular biopsies in azoospermic men seen at the Lagos State University Teaching Hospital; Ikeja - Lagos; Nigeria. Patients and Methods: A retrospective study of testicular biopsies of azoospermic men who presented to our institution from 2005 to 2006 was performed. The patient's age; type of infertility and histopathological diagnosis were evaluted. All biopsies were preserved in 10formaldehyde solution. Results: Of the 51 azoospermic men (mean age 30 years; range 25 - 46 years) 25 (49.0) had primary infertility; 11 (21.6) had secondary infertility and 15 (29.0) were not specified. Five (9.8) patients had normal spermatogenesis. Abnormal histological parameters occurred in 46 (90.2) patients: testicular atrophy in 30 (58.8); maturation arrest in 14 (27.5) and hypospermatogenesis in 2 (3.9) patients. Conclusion: The presence of normal spermatogenesis in azoospermic men; which would suggest an obstructive lesion; is not common in our practice; in contrast to previous studies from our country. This may indicate a changing pattern in the aetiology of male infertility in our environment. Identification of the possible causes of testicular damage resulting in non-obstructive azoospermia in our environment may help to prevent male infertility

The Pattern of Hysterosalpingographic Findings in Women Being Investigated for Infertility in Nnewi; Nigeria

Background: Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours. Objective: To review the pattern of hysterosalpingographic findings among women being investigated for infertility in Nnamdi Azikiwe University Teaching Hospital Nnewi; Nigeria over a period of five years (2001- 2005). Method: The data obtained from the request forms and radiologists' reports were analyzed using SPSS version 11. The level of statistical significance was set at p