Citation

Dhont N, van de Wijgert J, Luchters S, Muvunyi C, Vyankandondera J, Temmerman M. Hum. Reprod. 2010; 25(10): 2507-2515.

Affiliation

International Centre for Reproductive Health, Ghent University, Ghent, Belgium.

Copyright

(Copyright © 2010, Oxford University Press)

DOI

10.1093/humrep/deq189

PMID

20685757

Abstract

BACKGROUND In order to formulate cost-effective health interventions aimed at preventing infertility it is necessary to identify modifiable risk factors for infertility in sub-Saharan Africa. This case-control study examined potential predictors and their population attributable fraction (PAF%) for various infertility types including lifestyle factors, sexual behaviour and reproductive tract infections (RTIs). METHODS Sexually active women aged 21-45 year presenting with infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 283) were surveyed together with their male partners. Participants were interviewed about socio-demographic characteristics, sexual behaviours and lifestyle factors, and were tested for HIV and RTIs. RESULTS Variables significantly associated with tubal infertility were history of sexual violence adjusted odds ratio (AOR) 2.41; 95% CI 1.36-4.25; positive HIV (AOR 2.41; 95% CI 1.36-4.25), herpes simplex virus type 2 (HSV-2; AOR 1.67; 95% CI 1.03-2.71) and Chlamydia trachomatis serology (AOR 1.78; 95% CI 0.99-3.21), and current bacterial vaginosis by Amsel criteria (AOR 1.97; 95% CI 1.12-3.47). Among men, male factor infertility was associated with positive HIV (AOR 2.43; 95% CI 1.31-5.23) and HSV-2 serology (AOR 1.71; 95% CI 1.02-2.87) and current urologic abnormalities (AOR 2.38; 95% CI 1.01-5.31). Positive HSV-2 serostatus carried the greatest PAF% (26%) for tubal infertility, followed by positive HIV serostatus (20%) and history of sexual violence (17%). CONCLUSIONS Although temporal relationships are difficult to ascertain, history of sexual violence, HSV-2 infection and HIV infection are important predictors of infertility in Rwanda.

Language: en