Sexual violence, HSV-2 and HIV are important predictors for infertility in Rwanda

BACKGROUND: In order to formulate cost-effective health interventions aimed at preventing infertility it is necessary to identify modifiable risk factors for infertility in sub-Saharan Africa. This case-control study examined potential predictors and their population attributable fraction (PAF) for various infertility types including lifestyle factors, sexual behaviour and reproductive tract infections (RTIs). METHODS: Sexually active women aged 21-45 year presenting with infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 283) were surveyed together with their male partners. Participants were interviewed about socio-demographic characteristics, sexual behaviours and lifestyle factors, and were tested for HIV and RTIs. RESULTS: Variables significantly associated with tubal infertility were history of sexual violence [adjusted odds ratio (AOR) 2.41; 95 CI 1.36-4.25]; positive HIV (AOR 2.41; 95 CI 1.36-4.25), herpes simplex virus type 2 (HSV-2; AOR 1.67; 95 CI 1.03-2.71) and Chlamydia trachomatis serology (AOR 1.78; 95 CI 0.99-3.21), and current bacterial vaginosis by Amsel criteria (AOR 1.97; 95 CI 1.12-3.47). Among men, male factor infertility was associated with positive HIV (AOR 2.43; 95 CI 1.31-5.23) and HSV-2 serology (AOR 1.71; 95 CI 1.02-2.87) and current urologic abnormalities (AOR 2.38; 95 CI 1.01-5.31). Positive HSV-2 serostatus carried the greatest PAF (26) for tubal infertility, followed by positive HIV serostatus (20) and history of sexual violence (17). CONCLUSIONS: Although temporal relationships are difficult to ascertain, history of sexual violence, HSV-2 infection and HIV infection are important predictors of infertility in Rwanda.