Abstract
BackgroundSecondary infertility in developing countries is mostly attributable to blockage of the fallopian tubes due to adhesions caused by reproductive tract infections. There is a dearth of information on the prevalence and causes of secondary infertility from Pakistan. This paper presents results on factors associated with secondary infertility among married women in Karachi, Pakistan.MethodsA matched case-control study was conducted. Cases were women aged 15–35 years with history of at least one previous conception and currently seeking treatment for secondary infertility. Controls were women residing in the neighborhood of cases with at least one live birth and not taking treatment for secondary infertility. The age of controls was matched by ±5 years to that of cases. Data was collected from June to August 2003. Conditional logistic regression was used to determine crude and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI) for factors associated with secondary infertility.ResultsThe final multivariate logistic regression model revealed that after adjusting for age, cases were more likely to be the housewives (AOR = 2.6, 95% CI:1.5–4.4), had used inappropriate material to absorb blood during menstruation (AOR = 9.0, 95% CI: 5.0–16.4), and at their last delivery, had a birth attendant who did not wash hands with soap and water (AOR = 3.0, 95% CI: 1.4–5.7). Moreover, women with secondary infertility were more likely to report current or past history of having STI symptoms (AOR = 3.6, 95% CI: 2.4–5.6) and use of intra-vaginal indigenous medicines during their last post-partum period (AOR = 3.1, 95% CI: 1.6–5.7).ConclusionWe recommend health education and awareness messages for safe practices during menstruation, delivery, and the postpartum period for women in general. Additionally, sanitary napkins should be made available at an affordable cost, and safe delivery kits should contain educational/pictorial brochures for appropriate hand washing skills.
Highlights
A couple is generally considered infertile if they are unable to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse without use of contraceptives [1]
Primary infertility refers to couples who have never conceived whereas secondary infertility is usually defined as the inability to conceive for one year after having conceived at least once before [2]
Sexually transmitted infections (STIs) [9,10] as well as infections strewed through iatrogenic factors [11,12], unsafe termination of pregnancy [13,14], and unsafe birthing practices [15,16,17] have been identified as causes of secondary infertility in women from India, Bangladesh and Africa
Summary
A couple is generally considered infertile if they are unable to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse without use of contraceptives [1]. The prevalence of primary and secondary infertility in Pakistan is nearly 5% and 18% respectively [4,5]. Infections are the leading cause of secondary infertility among women [8]. Sexually transmitted infections (STIs) [9,10] as well as infections strewed through iatrogenic factors [11,12], unsafe termination of pregnancy [13,14], and unsafe birthing practices [15,16,17] have been identified as causes of secondary infertility in women from India, Bangladesh and Africa. Secondary infertility in developing countries is mostly attributable to blockage of the fallopian tubes due to adhesions caused by reproductive tract infections. This paper presents results on factors associated with secondary infertility among married women in Karachi, Pakistan
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