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Identification of main risk factors for tubal infertility
L Bahamondes1, J G Bueno, E Hardy
1Centro de Pesquisas e Controle das Doencas Materno-Infantis, Campinas, Brazil.
Objective:
To determine the relationship between some reproductive variables and infertility caused by tubal obstruction.
Design:
A retrospective, case-control study.
Setting:
A tertiary care university hospital that is a referral center for infertility patients.
Participants:
Subjects were interviewed between March 1990 and December 1991. Cases were 215 consecutively recruited infertile women with either evidence of tubal obstruction found at laparoscopy or hydrosalpinx diagnosed by hysterosalpingography. Women with a history of surgical sterilization were excluded. Controls, selected in the same hospital, were women in the puerperium who had no history of infertility. Two controls were matched by age at the time of tubal obstruction diagnosis to each case.
Results:
History of pelvic surgery and use of alcohol were significantly associated with the risk of infertility caused by tubal obstruction. The use of barrier, oral, and medroxyprogesterone acetate (MPA) contraceptives was associated with a protective effect. When only women with secondary infertility were analyzed, history of pelvic surgery and number of lifetime sexual partners were significant risk factors, and the previous use of oral contraceptives was the only protective factor.
Conclusions:
History of pelvic surgery was the most important risk factor for tubal infertility. All precautions must be taken to avoid infection and adhesion formation when pelvic surgery is performed. In addition, women can be protected from tubal infertility by using barrier, oral, or MPA contraceptive methods.