Clinical aspects of infertility and the role of health care services

Abstract

Rates of primary infertility worldwide are in the region of one to five per cent, with higher rates found in central Africa, while rates of secondary infertility range from seven to 33 per cent. This paper is about research carried out since the late 1970s by the Special Programme of Research, Development and Research Training in Human Reproduction on clinical aspects of infertility, with an emphasis on developing countries, particularly sub-Saharan Africa, where prevalence has been the highest in recent decades. Clinical studies have shown that prior pelvic inflammatory disease resulting from lower genital tract infection was the cause of primary infertility in women in sub-Saharan Africa in up to two-thirds of cases. Many tertiary health care facilities in developing countries are overwhelmed by demand for attention to infertility problems. In the 1990s, the Special Programme's research has focused on the ways in which health care services in developing country settings can respond to these problems through improving the prevention, diagnosis and treatment of infertility at primary, secondary and tertiary levels of care, and through the use of management guidelines appropriate to national and local settings.