Secondary Infertility of the Couple: Epidemiological and Clinical Aspects of Patients at the General Hospital of Loandjili in Pointe Noire (Republic of the Congo)

Abstract

Objective: Describe the epidemiological and clinical aspects and report the paraclinical anomalies in the case of secondary infertility of the couple to the General Hospital of Loandjili. Method: Descriptive cross-sectional study, conducted from January 1, 2017 to December 31, 2018, comprehensively including all the patients who consulted for secondary infertility, as defined by the World Health Organization (WHO). This involved the inability of a previously conceived couple to re-conceive and carry a pregnancy to term after a year or more of regular, unprotected sex for women under 35 years and after six months for women over 35. The presence of the spouse was required in the event of an abnormal spermogram. The variables studied were socio-demographic, reproductive, clinical, and para-clinical. Results: The couple's secondary infertility represented 25% of all Gynecology consultations (98/392). The patients were on average 34.7 ± 1.5 years old with a predominance of the 31 to 40 years age group. They were paucigest (2.8 ± 0.1) and pauciparous (1.8 ± 0.1), consulting for infertility with a median duration of 5 years. Their spouse had an average age of 41.3 ± 3.6 years. Clinically, 20% of patients had a history of pelvic surgery for benign gynecological disease. Biologically, genital infections were predominant (73.4%), most often associated with abnormalities of the cervical mucus (59.2%) and post coital test (37%). Regarding the spouse, spermogram abnormalities were noted in 45% of cases and dominated by oligozoospermia (35%). In 65% of cases, the antral follicle count was insufficient in 22% and zero in 6.2%. The indications for medically assisted procreation (MAP) were of the order of 20%, while only half had been able to benefit from this service abroad with six pregnancies including four deliveries with live children. Conclusion: Medically assisted procreation would be an alternative in the management approaches. Thus, efforts must be made to provide an appropriate response to that whose treatment requires this indication.