Primary and secondary infertility in Africa: systematic review with meta-analysis
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(2020) 6:20
RESEARCH ARTICLE
Open Access
Primary and secondary infertility in Africa: systematic review with meta-analysis Melese Shenkut Abebe1*, Mekbeb Afework2 and Yeshiwas Abaynew3
Abstract BACKGROUND: Infertility is a practical concern of Africans due to social disgrace and exclusion. This meta-analysis aims to analyze the proportion of primary and secondary infertility and identify the etiologic factors based on the studies conducted in Africa. METHODS: An internet-based search was conducted on the following databases; PubMed/Medline, EMBASE, Cochrane library, and google scholar. Both population and institution-based studies conducted among African couples, males, and females were included. Data extraction and critical appraisal of the articles were done by two independent investigators. Meta-analysis using a random effect model was conducted by Stata version 14. Forest plot, heterogeneity test, and funnel plot for publication bias were performed. RESULTS: The pooled proportion of primary and secondary infertility in Africa was 49.91% (I2 = 98.7, chi-square = 1509.01, degree of freedom = 19 and p < 0.001) and 49.79% (I2 = 98.7, chi-square = 1472.69, degree of freedom = 19 and p < 0.001) respectively. The pooled prevalence of the causes of infertility indicated that 54.01% and 22.26% of the infertility cases were respectively due to female and male-related problems. In 21.36% of infertility cases, both sexes were affected, while 10.4% of the causes of infertility were unexplained. The pooled prevalence of mostly reported causes of male infertility was 31% (oligospermia), 19.39% (asthenozoospermia), and 19.2% (varicocele). The most commonly identified causes of female infertility were pelvic inflammatory disease, tubal factors, and abortion with a pooled prevalence of 39.38%, 39.17%, and 36.41% respectively. Conclusions: In Africa, the proportion of primary and secondary infertility is approximately equal. Infertility is mostly due to female-related causes like; pelvic inflammatory diseases, uterine tube related problems, and abortion. Oligospermia, asthenozoospermia, and varicocele were the commonest causes of male-related infertility. It is suggested that interpretation and utilization of these findings should consider the presence of substantial heterogeneity between the included studies. Keywords: Africa, Meta-analysis, Primary infertility, Proportion, Secondary infertility
Introduction The clinical definition of infertility is an inability to be pregnant after 12 months or more of regular unprotected coitus [1]. From the demographer’s point of view, infertility is defined as the absence of live birth in a woman of reproductive age (15–49 years) with regular unprotected sexual * Correspondence: [email protected] 1 Department of Anatomy, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia Full list of author information is available at the end of the article
intercourse [2]. Infertility is classified as primary or secondary. Primary infertility is denoted for
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