African Journal for Infertility and Assisted Conception

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The challenges associated with infertility have necessitated different healthcare-seeking behaviors ranging from spiritual, traditional/alternative health care to orthodox medical types including biotechnological devices such as assisted reproductive technology (ART). ART is the highest breakthrough in the medical treatment of infertility in the whole world. Its evolution has presented multitudinous ethical, legal, and social challenges resulting in a tectonic shift in the way clinicians and the general population perceive infertility and ethics. Hence, there is a urgent need for stakeholders (fertility specialists, clients, professional organizations, religious bodies, bioethicists, and government) to formulate cultural and context-specific guidelines to help address some of these ethical dilemmas.

Introduction: Infertility is associated with adverse psychosocial effects and adoption provides a simple and affordable option for managing infertile couples, but are Nigerian women aware or willing to adopt? Methodology: This was a cross-sectional study. Interviewer-administered pretested questionnaires were given to a total of 236 consenting clients seen at their first visit to the gynecology clinic with complaints of inability to conceive, between the period of July 2016 to March 2018. Data on sociodemographics, gynecological, and infertility history was analyzed using the Statistical Package for the Social Sciences computer software version 22. Descriptive analysis was done using frequencies and percentages. Chi-square (and fishers test where relevant) was used as a test of association. Significance level was established at P < 0.05. Results: Majority of clients were aged between 20 and 29 years (44.5%), educated up to secondary level or above (80.9%), Muslims (65%), homemakers, and 59.3% had previous pregnancies. Most were aware about adoption (85.2%), but only 38.1% would consider adoption in the future. Respondents and husbands age, education, religion, respondents and husband's occupation, and knowing someone who had adopted in the past was significantly associated awareness of adoption. However, only order of marriage was significantly associated with willingness to adopt children in the future. Conclusion: Despite high levels of awareness, adoption is underutilized as most women have hope of having their own children or husbands may object. Couple counseling and community education are important for any change.

Objective: The objective was to determine the short-term outcome of unaided and microsurgical varicocelectomy on semen parameters and conception after 6 months in patients with infertility and varicocele. Patients and Methods: This was a randomized, prospective, interventional study that was conducted on men with infertility and varicocele. Patients were randomized into two groups. Patients in Group A underwent open inguinal varicocelectomy, whereas patients in Group B had the same surgery with microsurgical technique using ×3.5 magnification loupes. All the patients had preoperative seminal fluid analysis (SFA) performed on two occasions, a scrotal Doppler ultrasound and a postoperative SFA at 3 months and 6 months posttreatment. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) software package version 23.0, and the level of significance was taken as 0.05. Results: Thirty patients participated in the study, 14 in Group A and 16 in Group B. The mean age in Groups A and B was 40.07 ± 7.7 and 39.44 ± 7.3 years, respectively. About 85.7% of patients in Group A had bilateral varicocele, whereas 14.3% had left-sided varicocele. In Group B, 75% had bilateral, whereas 25% were on the left side. There was a statistically significant improvement in sperm count, motility, and morphology in both the unaided and the microsurgical groups; however, there was no significant difference in the improvement of seminal parameters between the two groups except the morphology. The pregnancy rate was 14.3% in Group A and 25% in Group B. Overall pregnancy rate in this study is 20% after 6 months. Conclusion: Varicocelectomy leads to significant improvement in sperm parameters; however, there is no significant difference in outcome between unaided and microsurgical varicocelectomy.

Background: Controlled ovarian hyperstimulation (COH) with intrauterine inseminations (IUI) is a commonly used method to treat infertile couples. This study aimed to evaluate prognostic factors responsible for successful pregnancy outcome in COH and IUI cycles. Materials and Methods: A cross-sectional study was carried out over a period of 1 year. A total of 130 women who visited the department of obstetrics and gynecology for the treatment of infertility were included in the study. Ninety-eight women were enrolled for this study, and proper screening protocol was followed. The outcome of COH-IUI cycles was assessed by evaluating many parameters such as age, duration of infertility, body mass index (BMI), etiology of infertility, endometrial thickness, and number of dominant follicles. Results: The mean age of pregnant women (25.40 ± 3.52 years) was significantly lower compared to nonpregnant women (28.01 ± 3.21 years) (P < 0.005). The mean BMI of pregnant women was 23.00 ± 2.41 kg/m² whereas the mean BMI of nonpregnant group was 25.12 ± 3.32 kg/m². This difference was statistically significant. Among pregnant women, 86.7% had bilateral patent fallopian tube and 88% in nonpregnant group had bilateral patent fallopian tube. In not getting pregnant group, the most common cause of infertility was unexplained in 80.7%, anovulatory cycles in 9.6%, and male factor infertility in 9.6%, whereas in pregnant group unexplained causes were found in 93.3% and male factor in 6.7%. No significant difference was observed between the two groups in terms of bilateral fallopian tube patency, antral follicular count, and endometrial thickness on the day of ovulation. There was no difference in pregnancy rates using either double IUI or single IUI. In our study, woman's age, BMI, and single dominant follicle were the main prognostic factors for successful outcome. Conclusions: In our study, woman's age, BMI, and single dominant follicle were the main prognostic factors for successful outcome.

Online since 12^th Aug, 2016