Gynecological co-morbidity, chronic illnesses and infectious diseases among black African women with primary or secondary infertility: should we be worried about hepatitis?

Abstract

Introduction: Female infertility may not occur alone but could be associated with other health conditions. Overlooking these health conditions during clinical assessment of women who present with primary or secondary infertility may not bring desired results of achieved pregnancy. Objective: To determine the frequency and relative risks of certain chronic illnesses such as hypertension and diabetes, infectious diseases such as hepatitis and other gynecological diseases such as uterine fibroid and endometriosis in women with primary and secondary infertility taking into consideration their age groups and body mass index. Study design: This was a retrospective study carried out at a tertiary health care facility in Lagos Nigeria. Methods: Records of patients who consulted for the management of infertility were retrieved for analysis. Result: The overall prevalence of hypertension, diabetes, cancer and asthma in all patients were 9.6%, 6.8%, 0.8% and 0.4% respectively. Among the infectious diseases, hepatitis B occurred most frequently at 19.1%, more among women with SI (28.0%) than PI (13.9%). The most prevalent gynecological diseases as co-morbidity were uterine fibroid (32.7%) and endometriosis (11.2%). Pooled analysis showed that there was a significant variation in the distribution of Polycystic ovarian syndrome (PCOS) (Pearson’s χ²=10.14, P-value=0.02) relative to age, no significant distribution of any disease relative to body mass index (BMI) in Kg/m2, significant distribution of intrauterine adhesion relative to age (years) and BMI among those with PI (Pearson’s χ²=9.80, P-value=0.04) but not in SI. Significant correlations were observed between infertility and hepatitis (r=0.17, P-value=0.006, 95% CI= 0.06, 0.36) and between infertility and fibroid (r=0.1868, P-value=0.003, 95% CI=0.07, 0.32). Conclusion: Through this study it is concluded that women with history of primary infertility are more at risk of diabetes, endometriosis and PCOS more than those with SI; conversely, those with SI are more at risk of hypertension, hepatitis, fibroid and adenomyosis. Gynecologists and fertility experts in sub-Saharan Africa should probe for these diseases in each patient who presents with infertility, after excluding male factor as contributing to female infertility. Early diagnosis of these diseases and others among infertile or sub-fertile women can minimize pain and reduce cost of hospitalization and also minimize the number of patients with unexplained infertility.