The burden of infertility in north-eastern Democratic Republic of Congo, a high-fertility region: a cross-sectional study.

Background: Infertility affects millions of couples worldwide and regions with high fertility rates are the most affected. This study aims to determine the proportion of infertile couples during gynecological consultations in Kisangani, identify the aetiological factors involved, and assess the responsibility of partners.

Methods: A cross-sectional study was conducted in seven health facilities in Kisangani, following a two-month campaign of free gynecological consultations in 2023. The ratios were subjected to Pearson's chi-square test or Exact Fisher with a significance level of p < 0.05. The data was analysed using Epi Info™ software version 7.2.2.6.

Results: Of the 1,434 female patients who consulted for a gynecological problem, 697 (48.61%) were infertile, predominantly secondary (78.78%) with a mean duration of 3.43 ± 2.79 years. Among the female reproductive system factors involved in infertility, ovarian factors was identified among 43.21% of cases, tubal factors among 64.63% of cases and uterine factors among 19.69% of cases. Polycystic ovarian syndrome (PCOS) was found to be associated with primary infertility, while bilateral obstruction and bilateral hydrosalpinx were associated with secondary infertility. Bacterial vaginosis was identified in 53.54% of patients, while 43.4% exhibited antisperm antibodies. A positive diagnosis for Chlamydia trachomatis was associated with secondary infertility. Among males, 44.55% of them had a sperm abnormality wich was in association to primary infertility. Oligospermia was the most prevalent semen abnormality (21.03%) and associated to primary infertility. Regarding partner responsibility, women was solely responsible in 25.23% of cases and men in 18.16%. Both partners were responsible in 29.06% of cases and in 27.53% of cases, the cause of infertility remained unexplained.

Conclusion: Infertility represents a significant public health concern in Kisangani, with approximately one-quarter of cases remaining unexplained. Given the high prevalence of bacterial vaginosis and anti-sperm antibodies, it is imperative to conduct studies to ascertain whether there is a correlation between these factors and unexplained infertility.