Volume 13, Issue 8 (9-2015)                   IJRM 2015, 13(8): 513-516 | Back to browse issues page

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Masoumi S Z, Parsa P, Darvish N, Mokhtari S, Yavangi M, Roshanaei G. An epidemiologic survey on the causes of infertility in patients referred to infertility center in Fatemieh Hospital in Hamadan. IJRM. 2015; 13 (8) :513-516
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-670-en.html
1- Research Center for Child and Maternity Care (RCCMC), Midwifery Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2- Chronic Disease Research Center, Mother and Child Health Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran , pparsa2003@yahoo.com
3- Nahavand Social Security Clinic, Hamadan, Iran
4- Malayer Mehr Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
5- Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
6- Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Introduction
 
Infertility means not having children after one year of regular sexual life without usage contraception techniques (1). Infertility is one of the major health care problems in all societies worldwide. The average prevalence of infertility in developed countries is 3.5-16.7% and in developing countries is 6.9-9.3% (2). The overall average of infertility was reported 13.2% in Iran (3). Causes of infertility are numerous such as anatomical, physiological and genetic factors. Many environmental and acquired factors also influence fertility and may lead to infertility. Menstrual and ovulation dysfunction and uterine factors are the most common causes of impairment in fertility. Etiology of infertility prevalence and patterns of causes of infertility in different regions are diverse. This discrepancy is due to existence of differences in environmental conditions associated with reproductive behaviors, such as age at marriage, environmental pollution, smoking and alcohol abuse, changing in lifestyle and diet (4). Although many studies have been conducted on the prevalence of infertility in the world, because infertility is increasing and the life style is changing and there is no comprehensive research in this area in Hamadan, it seems necessary to investigate the causes of infertility widely in Hamadan. Knowing the frequency of different causes of infertility in every region is important and can be effective in manager decisions. Due to the progress of methods of infertility treatment and the development of infertility treatment clinics in many cities of Iran, the majority of people within fertility problems after a while referred to these centers. Thus it seems that the infertile persons admitted to these centers can be a target population for the study of infertility in each region. In this study, different causes of infertility were examined in infertile couples.
 
Materials and methods
 
The statistical population of this cross-sectional study was including 1200 infertile couples that referred to specialized infertility clinic of Fatemieh Hospital, Hamadan, Iran during 2010-2011. The vice chancellor for research and technology of Hamadan University of Medical Sciences approved the study (3841-35-16). Informed written consent was obtained from all individuals. In this study samples were selected by sampling census method. The infertile couples were examined and diagnostic tests were done on them. Inclusion criteria included the completeness and reliability of the results. For this purpose those who had completed the examinations were evaluated. And also the results were confirmed by specialists. Men and women were at reproductive age and had primary or secondary infertility. Exclusion criteria were lack of full examinations and laboratory tests.
Demographic characteristics of persons are recorded and each pair was visited by the gynecologist and specialist in kidney and urinary tract. For men, the information related to puberty, cryptorchidism inguinal herniorraphy, testicular viral inflammation, and sexually transmitted diseases have been documented through questioning. Physical examination of testes was done in order to varices network spermatic cord (varicocele) or other lesions. The index survey of sperm in the semen was performed according to World Health Organization guidelines. Hormonal investigation was done if necessary. About women, information about the changes of puberty, menstruation, abnormal milk exit from breast, sexual desire and sexual activity was being asked. Genital examination includes cervical stenosis, natural cervical mucus, and formation of endometriosis has been done. Hormonal evaluation was performed for all women. The ovulation was evaluated using ultrasonography and also the openness of tubes was examined using X ray of uterus and fallopian tubes. If necessary in some cases, laparoscopic device was used to examine peritoneal cavity. Secondary infertility refers to cases in which couples have experienced at least one pregnancy and then after a year of regular sexual life without contraception were unable to have children.
 
Statistical analysis
In order to analyze our data we employed the analytics software, SPSS (Statistical Package for the Social Sciences version 16.0, SPSS Inc., Chicago, IL, USA) and the Chi-square test was used. P<0.05 were considered to be statistically significant.
 
Results
 
From 1200 infertile men and women, 834 cases (69.5%) suffered from primary infertility and 366 (30.5%) couples suffered from secondary infertility. Most infertile men (43.9%) were in the age group of 30-40 years and the majority of women (57.2%) were in the age group of 20-30 years. Average length of marriage of infertile couples was 91.6±63.8 month and their duration of infertility and sterility at the first visit in infertility clinic was 55.9±61.2 months. Overall 12.4% of couples had experience at least one of the assisted reproductive techniques such as micro injection, intra uterine infusion, in vitro fertilization, and zygote intrafallopian transfer. Of the total studied causes of infertility 88.9% was related to women factor and 66% was related to male factor. It should be noted that in some cases the couple may have more than one cause of infertility which overall all of the reasons have been investigated. Causes of infertility in women were as follows: menstrual disorders (disorders of cycle length and flow) 62.6%, diseases (obesity, thyroid diseases, diabetes) 58.7%, impaired ovulation (hormonal disorders, oligoovulation and anovulation) 50.3%, uterine causes 16.7%, tubal factor 15.4%, and cervical causes 7.9%. Abnormalities in uterine factors, hormonal dysfunctions in ovulation disorders, tubal obstruction in disorders of the fallopian tubes, cervical stenosis in cervical factor, dysfunction of cycle length in menstrual disorders, and obesity in diseases ha