TY - JOUR
T1 - The risk factor profile of women with secondary infertility
T2 - An unmatched case-control study in Kigali, Rwanda
AU - Dhont, Nathalie
AU - Luchters, Stanley
AU - Muvunyi, Claude
AU - Vyankandondera, Joseph
AU - De Naeyer, Ludwig
AU - Temmerman, Marleen
AU - van de Wijgert, Janneke
N1 - Funding Information:
This study was funded by a PhD grant from the Flemish Interuniversity Council (VLIR-UOS) and by the European and Developing Countries Clinical Trials Partnership (EDCTP) through a project entitled: “Preparing for Phase III vaginal microbicide trials in Rwanda and Kenya: Preparedness studies, capacity building, and strengthening of medical referral systems”. EDCTP cannot accept any responsibility for information or views expressed herein. The project also received funding from the “Walking Egg npo”, Genk 2000. We thank Rosette Busasa, Ammiel Gasarabwe and the Community Mobilizers for their dedication during data collection, Dr. Gilles Ndabisaya for programming of the database, and other members of the Projet Ubuzima team and the EDCTP microbicides project team for their contributions and support.
PY - 2011/6/24
Y1 - 2011/6/24
N2 - Background: Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.Methods: Between November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered (n = 219). Participants were interviewed about socio-demographic characteristics and obstetric history using structured questionnaires, and were tested for HIV and reproductive tract infections (RTIs).Results: Risk factors in the obstetric history for secondary infertility were lack of prenatal care in the last pregnancy, the first pregnancy before the age of 21 years, a history of unwanted pregnancy, a pregnancy with other than current partner, an adverse pregnancy outcome, stillbirth, postpartum infection and curettage. Presence of HIV, herpes simplex virus type 2 (HSV-2), or Treponema pallidum antibodies, and bacterial vaginosis (BV), were significantly more common in women in secondary infertile relationships than those in fertile relationships. The population attributable fractions (PAF%) for obstetric events, HIV, other (STIs), and BV were 25%, 30%, 27%, and 14% respectively.Conclusions: The main finding of this study is that obstetric events, HIV and other STIs contribute approximately equally to secondary infertility in Rwanda. Scaling up of HIV/STI prevention, increased access to family planning services, improvement of prenatal and obstetric care and reduction of stillbirth and infant mortality rates are all likely to decrease secondary infertility in sub-Saharan Africa.
AB - Background: Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.Methods: Between November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered (n = 219). Participants were interviewed about socio-demographic characteristics and obstetric history using structured questionnaires, and were tested for HIV and reproductive tract infections (RTIs).Results: Risk factors in the obstetric history for secondary infertility were lack of prenatal care in the last pregnancy, the first pregnancy before the age of 21 years, a history of unwanted pregnancy, a pregnancy with other than current partner, an adverse pregnancy outcome, stillbirth, postpartum infection and curettage. Presence of HIV, herpes simplex virus type 2 (HSV-2), or Treponema pallidum antibodies, and bacterial vaginosis (BV), were significantly more common in women in secondary infertile relationships than those in fertile relationships. The population attributable fractions (PAF%) for obstetric events, HIV, other (STIs), and BV were 25%, 30%, 27%, and 14% respectively.Conclusions: The main finding of this study is that obstetric events, HIV and other STIs contribute approximately equally to secondary infertility in Rwanda. Scaling up of HIV/STI prevention, increased access to family planning services, improvement of prenatal and obstetric care and reduction of stillbirth and infant mortality rates are all likely to decrease secondary infertility in sub-Saharan Africa.
UR - http://www.scopus.com/inward/record.url?scp=79959436460&partnerID=8YFLogxK
U2 - 10.1186/1472-6874-11-32
DO - 10.1186/1472-6874-11-32
M3 - Article
C2 - 21702916
AN - SCOPUS:79959436460
SN - 1472-6874
VL - 11
JO - BMC Women's Health
JF - BMC Women's Health
M1 - 32
ER -
