A study of infertility in Kenya: results of investigation of the infertile couple in Nairobi

A total of 379 couples presenting with infertility at the Kenyatta National Hospital (KNH) in Nariboi Kenya between 1977-78 were investigated. A complete history was taken and a physical examination was performed. If there was any clinical evidence of chronic pelvic inflammatory disease a prophylactic course of a broad spectrum antibiotic was given before any further tests are done to prevent a flare up of any quiescent infection. Thereafter semen analysis of the male partners was performed and the female partners were subjected to tests for tubal patency and ovulation. An endometrial culture for acid fast bacilli was done routinely. Of the 379 women who came to the gynecology clinic complaining of infertility during the period under review there was an almost equal number of cases of primary and secondary infertility i.e. 192. 45 women were in the age 20 or younger age group; 195 women were in the 21-25 year age group; 106 were in the 26-30 age group; 23 were in the 31-35 age group; and 6 were age 36 or older. Age was unrecorded for 4 women. At the initial pelvic examination of the women 287 (75.73%) were thought to have normal pelvic findings with no evidence of pelvic inflammatory disease. The remaining 92 had clinical evidence of the disease. Hysterosalpingography was performed on 320 women. For 65 patients hysterosalpingogram showed only 1 tube to be patent. The records revealed that 34 of them had a previous ectopic pregnancy with unilateral salpingectomy. Of the 295 patients who had a laparoscopy 78 showed a clean pelvis with bilaterally healthy tubes and bilateral free spill of the dye. The remaining 217 showed some evidence of pelvic inflammatory disease with 124 of them showing bilaterally blocked tubes. 31 had a trickle of dye (when injected under pressure) from 1 tube only. The 78 patients with healthy patent tubes had no other obvious pathology in the uterus ovaries pouch of Douglas or periadnexal area. Of the remaining 217 patients the site of obstruction was intestinal and/or isthmic (38) amullary (102) and fimbrial. Peritubal adhesions were seen in 217 patients. There were only 26 cases (10.61%) in which the laparoscopy gave a different impression of the patency of the tubes from the impression obtained at hysterosalpingography. 70 of the 379 men were found to have a semen volume of less than 1.5 ml. 43 had total azoospermia; 58 had oligospermia. A total of 101 were subnormal in their sperm counts. 14 of the 336 men (43 men with complete azoospermia excluded) had their semen specimens showing less than 50% of the sperms having normal oval heads. Of the total of 379 couples there was an obvious female factor in 240 and a male factor only in 69 couples. In 32 couples there were factors in both the male and the female which might have added up to give the infertility. In 38 couples no obvious factor could be detected in either the male or the female partner.