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Lessons learned from infertility investigations in the public sector
G W Stewart-Smythe1, B van Iddekinge
1Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg.
Summary
Tubal factor infertility is the most common cause of infertility in South Africa. Poor prognosis for bilateral tubal obstruction with hydrosalpinges suggests focusing on assisted reproductive techniques.
Area of Science:
- Reproductive Medicine
- Public Health
- Gynecology
Background:
- Infertility presents a significant challenge in South Africa, particularly within the public healthcare sector.
- Limited resources impact the investigation and treatment of infertile couples.
Purpose of the Study:
- To identify primary causes of infertility in an urban, tertiary hospital setting.
- To assess if major causal factors can rationalize and improve public sector infertility services.
Main Methods:
- Retrospective analysis of 206 women's hospital records.
- Inclusion of hysterosalpingogram results and couple infertility investigations.
Main Results:
- Bilateral tubal obstruction affected 65.5% of women, with 60% having significant hydrosalpinges.
- Semen analysis revealed low normal morphology (18%) in partners.
- Ovulation testing was positive in 73% of women, but compliance issues were noted.
Conclusions:
- Tubal factor infertility is the predominant cause identified.
- Poor prognosis for bilateral tubal obstruction with hydrosalpinges warrants consideration of assisted reproductive techniques.
- Recommendations for public sector infertility management are provided.