Academic journal article Bulletin of the World Health Organization

Estimation of the Prevalence and Causes of Infertility in Western Siberia

Academic journal article Bulletin of the World Health Organization

Estimation of the Prevalence and Causes of Infertility in Western Siberia

Article excerpt

Introduction

In recent years the prevalence of infertility has increased significantly in some countries. In the Russian Federation, for example, the birth rate over the period from 1987 to 1994 fell from 17.1 per 1000 to 10.8 per 1000 and since 1992 the reduction in the population has clearly been discernible (1). There is therefore an urgent need to carry out a detailed investigation of the factors that influence birth rate and, in particular, the infertile couple. The extent of infertility varies considerably among countries. According to WHO data, infertility becomes a public health problem when its frequency exceeds 15% (2), and the organization has developed guidelines for the study of the prevalence and causes of infertility (3).

Such investigations have never been carried out in the Russian Federation. One study of infertility that was carried out at the All-Union Institute of Obstetrics and Gynecology in Moscow, based on the WHO manual for the standardized investigation and diagnosis of the infertile couple (4), involved only patients attending a clinic; the results therefore did not reflect the true frequency of causes of the infertility in the general population.

The aim of the present study was to estimate and analyse the causes of infertility in Western Siberia using the methodological approaches recommended by WHO. This study is the first comprehensive investigation describing the reproductive function of the couple at the population level in the Russian Federation.

Materials and methods

The investigation was carried out in Tomsk -- a representative city in Western Siberia -- and was executed in two stages: the first involved selective epidemiological investigation followed by data processing; the second consisted of clinical evaluation of the infertile couple.

In the first stage we interviewed 2000 married women aged 18-45 years using questionnaires developed by WHO. Women from the general population were chosen randomly from polling station lists of the electorate in order not to influence the representativeness of the selection. There are about 2000-3000 voters registered at each polling station, of which about 30-40% are female. Every seventh woman was included in the selection and was requested to answer a questionnaire dealing with general medical, menstrual, reproduction, and contraception histories. In this way, the fertile status of every participating woman was defined.

In accordance with the recommendations of workers who have investigated the prevalence of infertility in other countries (5), 3500 married women aged 18-45 years were included in the sample population. Of these, only 2000 answered all the questions on the form. The remaining 1500 women refused to answer some questions and were excluded from further analysis. A total of 333 couples (16.7%) were considered to be infertile since they had not conceived after 12 months or more of unprotected intercourse.

For the second stage of the investigation, the infertile couples were offered a comprehensive medical investigation at the gynaecological clinic of the Siberian Medical University and Regional Centre for Human Reproduction in accordance with the WHO manual for the standardized investigation and diagnosis of the infertile couple (4). For 254 couples, both partners agreed to undergo the comprehensive medical investigation but only 186 couples completed it. In the other 68 cases the investigation remained incomplete as one or other of the partners refused or the couple moved away from the area; these couples were excluded from further analysis. In the diagnosis of the causes of infertility, the following investigations were carried out: semen analysis in accordance with WHO recommendations; and tests of tubal patency by laparoscopy, ovulation, and endocrine profile in accordance with WHO guidelines for the radioimmunoassay of hormones (6).

Results

Epidemiology of infertility

The overall infertility rate in Tomsk was 16. …

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