EPIDEMIOLOGY OF INFERTILTY IN KANO, NORTH-WEST NIGERIA

INTRODUCTION: Infertility is a global problem with the highest prevalence in sub-Saharan Africa. Despite the high prevalence it has been a relatively neglected problem, overshadowed by seemingly greater concerns such as maternal mortality. OBJECTIVES: The aim of this study is to identify the prevalence, clinical pattern and causes of infertility among gynaecological patients in Aminu Kano Teaching Hospital. METHODOLOGY: It was a retrospective study of infertile patients who presented at the gynaecology clinic of Aminu Kano Teaching Hospital, between 1st January 2016 and 31st December 2017. RESULTS: The prevalence of infertility was 16%. The ages of the patients ranged from 18 to 46 years, with a mean age of 28.72+6.0 years. The mean duration of infertility was 5.97 ± 4.19 years with maximum duration of 28 years. Majority of the patients had secondary infertility (53%) while 47% had primary infertility. Female factors accounted for 44.6% of the infertility, while male factors accounted for 23%. Among the female causes of infertility tubal factors accounted for 46%, ovulatory factors accounted for 41% while uterine factors accounted for 13%. CONCLUSION: Prompt diagnosis of infection and


Department of Obstetrics and Gynaecology Bayero University,
Kano/Aminu Kano Teaching Hospital, Kano, Nigeria traditional healers before going to hospital.When they finally present to the hospital, they tend to jump from one practitioner to another.Sometimes they go back to traditional healers because of the high cost of investigations and 5 treatment .These are among the factors that made it difficult to determine the exact prevalence and clinical pattern of infertility in Sub Saharan Africa.Data from population-based studies suggest that 10-15% of couples in the Western world 6 experience infertility .In Sub-Sahara Africa the prevalence of infertility has been noted to There is paucity of data on the epidemiology of infertility in Aminu Kano Teaching hospital, hence the need for the study to fill the existing knowledge gap.The aim of this study is therefore to identify the prevalence, clinical pattern and causes of infertility among gynaecological patients in Aminu Kano Teaching Hospital.

METHODOLOGY
This was a retrospective study conducted at the gynecology clinic of Aminu Kano Teaching Hospital, Kano.Participants in the study included women who attended the gynaecology clinic over a 2 year period, from 1st January 2016 to 31st December 2017, with history of inability to achieve conception of at least 1 year duration despite regular and unprotected sexual intercourse.Their folders were retrieved from the medical record department of the hospital and a proforma was used.
All the patients who had full history, physical examination and complete investigations were included in the study.Their weights and heights were used for calculating the body mass index (BMI).BMI was classified according to World Health Organization classification.All the patients who had a pelvic ultrasound scan, seminal fluid analysis, and hysterosalpingography (HSG) were included in the study.Women with menstrual irregularities and/or other features of anovulation who were further investigated with measurement of hormone levels were also included.Only female patients with full investigations and male partners that did seminal fluid analysis were included in the study analysis.
The relevant clinical findings and results of investigations were documented using a proforma.Information on the ages, educational status, duration of infertility, type of infertility, contribution of male factor, female factor or combinations were extracted from the proforma and analyzed using SPSS version11.

RESULTS
The total number of new gynecological cases during the study period was 1,715.Out of these, 318 folders were retrieved with a diagnosis of infertility, but only 278 were analyzed, 13 folders had incomplete information while 27 had incomplete investigations.
The sociodemographic characteristics of the patients are shown in table 1.The ages of the patients ranged from 18 to 46 years, with a mean age of 28.72+6.0years.Majority (51.1%, n=142) had secondary education.The duration of infertility in most of the patients (57.6%, n=160) ranges between 1 and 5 years.The mean duration of infertility was 5.97 ± 4.19 years with maximum duration of 28 years.Table 2 shows the obstetrics history of the patients; majority were nulliparous (55.4%, n=154) and the mean parity was 0.74 + 1.10.The maximum number of living children was 5, although majority of the patients had no living children (64.4%, n=179).Table 3 shows the clinical features of the patients.Majority present with vaginal discharge (51.1%,), irregular menstruation (36%) and chronic lower abdominal pain ( 29.1%).The common examination findings (Table 4) include abnormal BMI found in 45% of the patients.Those who are overweight accounted for 28.4%, 14% were obese while 2.5% were underweight.Other findings include hirsutism (12.9%), abnormal vaginal discharge (6.5%), abdominal swelling (5.4%) and galactorrhoea (4.3%).Majority of the patients had secondary infertility (53%) while 47% had primary infertility (Figure 1).Following analysis of investigation results female factors alone accounted for 44.6% of the infertility, while male factors alone accounted for 23%.
Combined male and female factors accounted for 18.3% of the cases, while 14% were unexplained (Figure 2).Among the female causes of infertility tubal factors accounted for 46%, ovulatory factors accounted for 41% while uterine factors accounted for 13%.

DISCUSSION
The prevalence of infertility in this study was 16%.This prevalence is similar to the   previous visits to traditional healers .In this study secondary infertility has also been found to be more prevalent (53%) than primary infertility (47%).This is similar with findings from several other studies in sub- infertility in developing countries .This further confirms the findings that infection is the commonest cause of infertility in Nigeria.

CONCLUSION
Infertility is one of the commonest presenting complaints among gynaecological patients in Nigeria.Since most of the causes of infertility in the study population is due to infection; prompt diagnosis of infection and adequate treatment will go a long way in preventing the dreaded sequelae of infertility.Emphasis should also be on primary prevention by health education on safer sex practices.Availability and affordability of assisted reproductive techniques in public hospitals will go a long way in providing solution to these couples as it is the effective option of treatment for the commonest cause of infertility in the study area.