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Patterns of infertility in the developing world: preliminary observations from the WHO clinical study, Task Force on the Diagnosis and Treatment of Infertility, WHO Special Programme of Research, Development and Research Training in Human Reproduction.
[Unpublished] 1984 Feb. 11 p.This paper presents preliminary observations on infertility derived from a World Health Organization (WHO) clinical study conducted in 33 medical centers in 25 developed and developing countries. A major purpose of the investigation was to provide a standardized approach, including standardized diagnostic procedures and identical definitions, for the study of infertile couples. As of January 1984, 7600 couples had been enrolled in the study and over 5400 had completed the protocol. Infertility of at least 1 year's duration was required for admission to the study. The study results so far suggest certain patterns. Couples in developed countries were more likely to have primary than secondary infertility and to have been infertile for a shorter period of time than those in developing countries. However, Africa was the only area in which the majority of couples requesting medical consultation had secondary infertility. Over 70% of couples in developing countries had infertility for over 2.5 years before seeking consultation, whereas half of those in developed countries waited less than 2 years. On the other hand, similar proportions of couples (13-16%) in all regions became pregnant. Reasons for infertility were identified in both partners in 1/3 of African couples and 40% of those in the East Mediterranean region. The rate of infertility of unexplained etiology was 9-20% in developed countries, Latin America, and Asia, but 0% in Africa and 5% in the East Mediterranean. Over half of African women had infection-attributable diagnoses (including 43% bilateral tubal occlusion, 15% pelvic adhesions, and 4% acquired tubal abnormalities), a rate that was 60% higher than in other areas. Similarly, varicocele was diagnosed in 25% of African males investigated compared with 6-19% in other areas. Abnormal sperm morphology and low sperm motility were also more common among African males. Higher risks of tubal occlusion were consistently associated with number of previous pregnancies, a history of sexually transmitted infections, and a previous episode of postpartum or postabortal complications.