Infertility.

PIP: Infertiliy factors encountered in everyday practice in East Africa are reviewed and treatment methods are reported. In a personal series of 220 patients with bilateral tubal occulusion, tubal surgery was undertaken in 52 cases, only 3 of which are known to have produced live births. Reinfection occurred in a large number of cases, indicating the need to maintain prophylactic antibiotics for at least 3 months postoperatively. 6 additional patients with secondary infertility were found to have sustained significant cervical laceration in a previous delivery. After cervical repair, 4 of the 6 had successful pregnancies. A pregnancy rate of 30-50% can be expected after fibroids are removed. East Africa lacks facilities for gonodotropic hormone level estimation. However, clomiphene citrate is widely used by gynecologists. It is administered in doses of 100-200 mgm/day on the 5th-9th days of the menstrual cycle. 10 pregnancies resulted among the last 50 patients treated with clomiphene for anovulatory infertility. Male factors are estimated to account for 20-30% of infertility. At least 3 semen analyses must concur for acceptance of a diagnosis of infertility or subfertility. Spermatogenesis may be enhanced by the testosterone rebound method or human pituitary gonadotropin therapy. It is estimated that about 50% of infertile couples can be helped within the 1st year based on information gained from a careful history and examination and routine blood and urine investigations.^ieng