The burden of infertility in North-Eastern Democratic Republic of Congo, a High-Fertility Region: A Cross-Sectional Study

Abstract

Background Infertility affects millions of couples worldwide and regions with high fertility rates are the most affected. This study aims to determine the prevalence of infertility in couples in Kisangani, identify the aetiological factors involved, and assess the responsibility of partners. Methods A cross-sectional study was conducted in seven health facilities in the city of Kisangani following a two-month campaign of free gynaecological consultations. The ratios were subjected to a Pearson's chi-square test or Exact Fisher with a significance level of p < 0.05. Results Of the 1,434 patients who consulted us for a gynaecological problem, 697 (48.61%) were infertile. Factors associated to infertility were polygamous relationship (p-value = 0.0000), first sexual intercourse before the age of 18 (p-value = 0.0000), having unprotected sex with a non-regular partner in the previous six months (p-value = 0.0047), history of treated genital tract infections in the previous six months (p-value = 0.0106) and history of abdominal-pelvic surgery (p-value = 0.0000). Among female causes of infertility, ovarian factors associated with primary infertility (p-value = 0.0172) represented 43.21% of cases, with PCOS as the major factor (31.74%). Uterine factors represented 19.69% of cases, with fibroid as the major factor (18.75%). Tubal factors represented 64.63% of cases, with bilateral obstruction (p-value = 0.0115) and bilateral hydrosalpinx (Exact Fisher = 0.0385) associated with secondary infertility. 53.54% of patients had bacterial vaginosis and 43.4% of them had antisperm antibody. Chlamydia Trachomatis was associated to secondary infertility (p-value = 0.0419). Among male, 44.55% of them had a sperm abdomality wich was in association to primary infertility (p-value = 0.0129). Oligospermia was the most prevalent (21.03%) and associated to primary infertility (p-value = 0.0113). Regarding partner responsibility, women was solely responsible in 25.23% of cases and men in 18.16%. Both partners were responsible in 29.06% of cases and in 27.53% of cases, the cause of infertility remained unexplained. Conclusion Infertility represents a significant public health concern in Kisangani, with approximately one-quarter of cases remaining unexplained. Given the high prevalence of bacterial vaginosis and anti-sperm antibodies, it is imperative to conduct studies to ascertain whether there is a correlation between these factors and unexplained infertility.