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Africa – Uganda: Causes and Effects of Infertility

October 16 , 2013
by: ASRM Office of Public Affairs
Published in ASRM Press Release

HIGHLIGHTS FROM THE INTERNATIONAL FEDERATION OF FERTILITY SOCIETIES 21st WORLD CONGRESS ON FERTILITY AND STERILITY AND THE  69th ANNUAL MEETING OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE

An infertility clinic held in Uganda by Saint Francis Mutolere Mission Hospital (Kisoro, Uganda) and Albert Einstein School of Medicine (New York, NY) showed that causes and diagnoses of infertility in Africa are similar to those in the United States, Europe, and Asia. 

The two-week clinic was advertised on the radio and attracted 110 female patients and 73 male patients.   Male patients received semen analysis and female patients were evaluated by hysterosalpingogram for uterine and tubal factors and by menstrual calendar for ovulatory factors.

Contrary to a commonly-cited 1985 study suggesting that most African infertility is secondary and due to tubal factors, the majority of couples reporting to the Saint Francis-Albert Einstein clinic had primary infertility (66%) and the incidence of tubal and ovulatory dysfunction was practically equal (26% and 25%).  Thirty-three percent of the men's semen analyses were abnormal, with eight patients found to have no sperm in their ejaculate.

Commenting, Dr. David Adamson of the IFFS said, "Beyond raising questions about widely held assumptions, the data gathered at the clinic show that infertility evaluation and services are much needed in rural Africa and that their delivery is feasible."

O-469 Etiology of Infertility in Rural Africa
J Mugisha et al
 

Another study coming out of Uganda, informs us about the far-reaching impact infertility may have on women's lives in the developing world.  Preliminary data gathered from April to June 2013 at the infertility and prenatal clinics of Mulago National Hospital in Kampala reveal a trend that infertile patients are 2.3 times more likely to be threatened at home and 2.1 times more likely to be the victim of physical violence inflicted by their intimate partner. 

The stigma of infertility is such that 59% of women said that they would rather be infected with HIV than be infertile (14.5% of study participants were HIV +).  Infertile women reported 40% more often than fertile women that their husband had a girlfriend or another wife.

Male factor infertility was unrecognized, with only one of 83 subjects knowing that it is one of the three main causes of infertility.   Modern contraceptives were thought by 53% of respondents to be a cause of infertility.

Professor Joe Leigh Simpson, IFFS President said, “Infertility as a disease, and no disease should be a stigma, or an excuse for violent or threatening behavior. Infertility may be due to a problem affecting either a male or female partner, but in many cases it can be treated successfully. There is no doubt that people need to be better educated about infertility, and this is especially true where people don’t have access to highly developed medical facilities.”

O-470 Infertility and Gender-Based Violence in Kampala, Uganda
M Shah et al
 

Representing more than 50 fertility societies from around the globe, the International Federation of Fertility Societies (IFFS) is the world’s principal international fertility organization. The IFFS was founded in 1951, and held its first congress in New York in 1953. The IFFS mission is to stimulate basic and clinical research, disseminate education and encourage superior clinical care of patients in infertility and reproductive medicine. Website: http://www.iffs-reproduction.org/ 

The American Society for Reproductive Medicine, founded in 1944, is an organization of more than 7,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.  Affiliated societies include the Society for Assisted Reproductive Technology, the Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, the Society of Reproductive Surgeons and the Society of Reproductive Biologists and Technologists.


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