Abstract
BackgroundFemale infertility is a multifactorial condition constituting a worldwide public health problem. The ability to reproduce is an important product of any marriage, hence infertility may exert a negative impact on physical, financial, social and emotional wellbeing of affected couples. The cornerstone to the management of any disease, including infertility, is prevention. Identifying the modifiable risk factors of female infertility will aid at prevention, early detection, and treatment of medical conditions that can threaten fertility as well as promoting healthy behaviours that can preserve it.AimTo explore the risk profile of infertility among Qatari women and compare risk factors distribution among primary vs. secondary infertility.MethodologyA hospital-based case control study was conducted from September 17th, 2017- February 10th, 2018. Cases (n = 136) were enrolled from infertility clinic and controls (pregnant women, n = 272), were enrolled from antenatal clinic, Women Hospital, Hamad Medical Corporation (HMC). Interview questionnaire was utilized to collect data about sociodemographic, risk factors related to infertility and patient health Questionnaire (PHQ)-2. Body Mass Index (BMI) was calculated. Logistic regression was used to identify the associated factors to infertility. Statistical significance was set at 0.05.ResultsForty three primary and ninety three secondary infertility cases were included. Risk factors were age > 35 years (OR = 3.7, 95% CI: 1.41–9.83), second-hand smoking (OR = 2.44, 95% CI:1.26–4.73), steady weight gain (OR = 4.65,, 95% CI: 2.43–8.91), recent weight gain (OR = 4.87, 95% CI: 2.54–9.32), menstrual cycle irregularities (OR = 4.20, 95% CI:1.14–15.49), fallopian tube blockage (OR = 5.45, 95% CI: 1.75–16.95), and symptoms suggestive of sexually transmitted infections (STIs) including chronic lower abdominal/pelvic pain (OR = 3.46, 95% CI: 1.57–7.63), abnormal vaginal discharge (OR = 3.32, 95% CI:1.22–9.03) and dyspareunia (OR = 7.04, 95% CI: 2.76–17.95). Predictive factors for secondary infertility were; longer time from previous conception (OR = 5.8, 95% CI: 3.28–10.21), history of stillbirth (OR = 2.63, 95% CI: 1.04–6.67) or miscarriage (OR = 2.11, 95% CI: 1.21–3.68) and postpartum infection (OR = 3.75, 95% CI: 1.27–11.06). Protective factors were higher education level (OR = 0.44, 95% CI: 0.25–0.78), higher income (OR = 0.17, 95% CI: 0.06–0.49), and awareness/loyalty to fertility window (OR = 0.33, 95% CI: 0.21–0.52 and OR = 0.29, 95% CI: 0.19–0.44, consequently).ConclusionThis study highlighted the opportunities to strengthen public health as well as hospital-based health promotion programs importantly toward behavioural-related risk factors (e.g. smoking, obesity, STIs etc.). Moreover, detecting, preventing, and managing modifiable risk factors through awareness, screening and early management of chronic diseases, may contribute at reduction of incidence and severity of infertility. Such interventions can be delivered at premarital, family planning, post-natal and antenatal clinics at primary health care with early referral to secondary care if required.
Highlights
Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse [1, 2]
Risk factors were age > 35 years (OR = 3.7, 95% Confidence interval (CI): 1.41–9.83), second-hand smoking (OR = 2.44, 95% CI:1.26–4.73), steady weight gain (OR = 4.65, 95% CI: 2.43–8.91), recent weight gain (OR = 4.87, 95% CI: 2.54–9.32), menstrual cycle irregularities (OR = 4.20, 95% CI:1.14–15.49), fallopian tube blockage (OR = 5.45, 95% CI: 1.75–16.95), and symptoms suggestive of sexually transmitted infections (STIs) including chronic lower abdominal/pelvic pain (OR = 3.46, 95% CI: 1.57–7.63), abnormal vaginal discharge (OR = 3.32, 95% CI: 1.22–9.03) and dyspareunia (OR = 7.04, 95% CI: 2.76–17.95)
Several risk factors of female infertility might be preventable the ones related to behaviour and lifestyle
Summary
Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse [1, 2]. Female infertility risk factors ranges from non-modifiable such as older age, ethnic background, congenital anomalies of reproductive organ, certain genetic conditions, family history [12,13,14], and modifiable factors that include sociodemographic, STIs, post-abortal or postpartum infections leading to fallopian tube blockage, high risk sexual behaviour (e.g. early age at first sexual intercourse, multiple marriages/relations), environmental hazards (e.g. radiation exposure, chemotherapeutic and toxic agents), lifestyle factors (e.g. obesity, tobacco smoking, alcohol intake, emotional stress, etc.), some medical conditions (as menstrual cycle abnormalities, thyroid diseases, polycystic ovarian syndrome (PCOS)), and prior history of pelvic surgeries (e.g. caesarean section, appendectomy) [15,16,17,18]. Identifying the modifiable risk factors of female infertility will aid at prevention, early detection, and treatment of medical conditions that can threaten fertility as well as promoting healthy behaviours that can preserve it
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