Abstract
BackgroundSecondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.MethodsBetween November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered (n = 219). Participants were interviewed about socio-demographic characteristics and obstetric history using structured questionnaires, and were tested for HIV and reproductive tract infections (RTIs).ResultsRisk factors in the obstetric history for secondary infertility were lack of prenatal care in the last pregnancy, the first pregnancy before the age of 21 years, a history of unwanted pregnancy, a pregnancy with other than current partner, an adverse pregnancy outcome, stillbirth, postpartum infection and curettage. Presence of HIV, herpes simplex virus type 2 (HSV-2), or Treponema pallidum antibodies, and bacterial vaginosis (BV), were significantly more common in women in secondary infertile relationships than those in fertile relationships. The population attributable fractions (PAF%) for obstetric events, HIV, other (STIs), and BV were 25%, 30%, 27%, and 14% respectively.ConclusionsThe main finding of this study is that obstetric events, HIV and other STIs contribute approximately equally to secondary infertility in Rwanda. Scaling up of HIV/STI prevention, increased access to family planning services, improvement of prenatal and obstetric care and reduction of stillbirth and infant mortality rates are all likely to decrease secondary infertility in sub-Saharan Africa.
Highlights
Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries
Of 339 women in infertile relationships who presented at the study clinic, 312 were confirmed eligible for the study and enrolled
Of 407 women in fertile relationships identified in the community, 352 (86%) came to the clinic and 312 eligible women were enrolled
Summary
Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. Secondary infertility is usually defined as the inability to conceive despite exposure to pregnancy for one year (2 years in some epidemiological studies), after having conceived at least once before [1]. This implies that women with secondary infertility do not necessarily have a living child. In an analysis of Demographic Health Surveys (DHS) from different Central-African countries risky sexual behaviour such as multiple unions, transactional sex and early age at first intercourse were associated with secondary infertility [7]. Since most of secondary infertility is preventable, a better knowledge of modifiable risk factors may help to develop interventions targeted at those most at risk
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