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  1. 1

    Primary and secondary infertility in Tanzania.

    Larsen U

    Journal of Health and Population in Developing Countries. 2003 Jul 2; [15] p..

    The trend and predictors of infertility are not well known in sub-Saharan Africa. A nationally representative Demographic and Health Survey (TDHS) was conducted in Tanzania in 1991/92, 1996 and 1999, enabling a trend study of infertility. Logistic regression was used to determine the predictors of infertility. The prevalence of primary infertility was about 2.5%, and secondary infertility was about 18%. There was no change between the 1991/92, 1996 and 1999 TDHS. The risk of primary infertility was higher in the Dar es Salaam and Coast regions than in other regions and secondary infertility was higher in the Dar es Salaam region. The Dar es Salaam and Coast regions are known for also having elevated levels of HIV/AIDS. Because sexual practices and sexually transmitted diseases are strong predictors of pathological infertility and HIV infection in Africa, we recommend that concerted efforts be made to integrate the prevention of new incidences of infertility with the HIV/AIDS campaigns. (author's)
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  2. 2

    Prevention of infertility.

    In: Challenges in reproductive health research: biennial report 1992-1993, edited by J. Khanna, P.F.A. Van Look, P.D. Griffin. Geneva, Switzerland, World Health Organization [WHO], Special Programme of Research, Development and Research Training in Human Reproduction, 1994. 161-6.

    The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction is conducting research on the subsequent fertility of women admitted to hospital with clinically suspected pelvic infection. Results available so far suggest that fertility up to 24 months after the original hospitalization is adversely affected to a degree which is proportional to the severity of the disease. Findings from a study treating 112 oligozoospermic men with mesterolone will be published in 1994. The program made significant progress in its research on the development of a simple diagnostic test specific for acute chlamydial infection of the genital tract. The test is based upon the detection of a secretory immunoglobulin A antibody specific to Chlamydia. As for condom preference, a study found male sex workers in Thailand engaged in sexual networks involving male and female clients and girlfriends. The female condom received favorable feedback from women at high risk of sexually transmitted disease (STD) transmission in Zimbabwe, as well as from their clients and steady partners. A study of approximately 300 female prostitutes in Bangkok found only 2% opting for condoms lubricated with silicone oil compared to 86% opting for condoms lubricated with nonoxynol-9. Past STD infection in selected groups, gynecological health, and chlamydial vaccine research are discussed.
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  3. 3

    Levels, age patterns and trends of sterility in selected countries South of the Sahara.

    Larsen U

    In: International Population Conference / Congres International de la Population, Montreal 1993, 24 August - 1st September. Volume 1, [compiled by] International Union for the Scientific Study of Population [IUSSP]. Liege, Belgium, IUSSP, 1993. 593-603.

    Using data collected in cooperation with the World Fertility Surveys (WFS) and the Demographic and Health Surveys (DHS) the aim was to determine the levels, age patterns, and trends of sterility in benin, Burundi, Cameroon, Ghana, Ivory Coast, Kenya, Lesotho, Liberia, Mali, Mauritania, Nigeria, Senegal, Sudan, Togo, and Uganda. In sub-Saharan Africa, 10 countries completed a WFS survey from 1977 to 1982. From 1986 to 1991 a DHS survey was carried out in 13 countries. In Sudan, Lesotho and Mauritania only ever married women were eligible for interview. All women (generally age 15-49) were eligible in the rest of the sub-Saharan countries. The selected samples included women who had been sexually active at least 5 years. Subsequently the levels and range patterns of sterility were estimated for each country and by produce within each country. The inhibiting effect of sterility on fertility was also assessed. Age-specific rates of sterility were estimated by the subsequently infertile estimator. At age 34, the proportions sterile reached .41 in Cameroon, .11 in Burundi, and intermediate levels in the rest of the countries. Burundi had the lowest prevalence of sterility at all ages, Cameroon had the highest up to about age 42, and at older ages Sudan and Lesotho ranked highest. In general, sterility rose moderately up to age 35 and then more rapidly after age 40. Sterility was particularly prevalent along major rivers, lakes, and coastal areas. Sterility was relatively high around Lake Victoria as well as in the Coast region of Kenya in 1977-78. Primary sterility was less than 3% in Burundi, Ghana, Kenya, Togo, and in Ondo state, Nigeria; 3-5% in Lesotho, Liberia, Mali, and Nigeria (1990), Senegal, Sudan (1989-90) and Uganda; and 5% or more in Cameroon, Nigeria (1981-82), and Sudan (1978-79). Differential disease patterns caused the most variation in age-specific rates of sterility. Under the hypothesis of Burundi levels of age specific sterility and unchanged fertility, and African woman in the age range from 20 to 44 would have an additional .5 to 2 children.
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  4. 4
    Peer Reviewed

    [Reproductive health in a global perspective] Reproduktiv helse i globalt perspektiv.

    Bergsjo P

    TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1991 May 30; 111(14):1729-33.

    The 4 cornerstones of reproductive health according to the WHO are family maternal care neonatal and infant care, and the control of sexually transmitted diseases. In recent years, the AIDS epidemic has caused concern in the world. The world's population doubled to 4 billion from 1927 to 1974, and it will reach 6 billion by the year 2000. The rate of growth is 1.4% in China and 2% in India vs. .3% in Europe. Contraceptive prevalence is 15-20% in Africa, 30% in South Asia, and 75% in East Asia. Shortage of contraceptives leads to abortion in eastern Europe. In 1985 in the USSR, there were 115.7 abortions/1000 women (mostly married) aged 15-44; and 6.4 million abortions for 5.5 million births in 1989. RU-486 or mifepristone combined with prostaglandin has produced abortion in 90% of first trimester pregnancies. After approval in France in 1987, it was used in 40,000 abortions in the following year. 90% of the estimated annual 500,000 maternal deaths occur in developing countries. In Norway, the rate is fewer than 10/100,000 births vs. 100/100,000 in Jamaica. In the mid-1980s, 26% of rural women in Thailand, 49% in Brazil, 54% in Senegal, and 87% in Morocco went without maternal care. In Norway, infant mortality is 6-8/1000 live births vs. 75-150/1000 in developing countries. A WHO investigation on causes of infertility in 25 countries found a 31% rate of tubal pathology in 5800 couples. In Africa, over 85% f infertility in women was infection related. Venereal diseases and infertility are associated with premarital sexual activity in young people. Various donor agencies and the WHO Special Program of Research, Development, and Research Training in Human Reproduction are providing help and resources including AIDS research.
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  5. 5

    Population dynamics of rural Cameroon and its public health repercussions. A socio-demographic investigation of infertility in Mbandjock and Jakiri districts.

    Lantum DN

    Yaounde, Cameroon, Public Health Unit, Univ. Centre for Health Sciences, Univ. of Yaounde, 1979 Oct. 314 p.

    The preliminary findings of the Vital Statistics Survey Project, conducted under the auspices of the University of Yaounde in 2 rural districts of Cameroon in 1975-78, are reported. Vital statistics surveys were conducted in 20 villages in the Jakiri district and 3 villages in the Mbandjock district in 1976. Longitudinal surveys were conducted in 1976-77 and again in 1977-78 in Jakiri and in 1976-77 in Mbandjock. Jakiri's population is characterized by high fertility and high mortality. In contrast, Mbandjock shows low fertility and a stagnant or decreasing population trend. Data on factors related to fertility were collected from 3592 women in Jakiri and 251 women in Mbandjock. The crude birth rate in Jakiri was 37.5 livebirths/1000 population in 1976-77 and 27.5/1000 in 1977-78. In Mbandjock, the 1976-77 rates were 20.1, 31, and 12/1000 in the 3 villages surveyed. The average number of living children per woman was 2.67 in Jakiri and 1.55 in Mbandjock. 68.9% of Jakiro women and 79% of Mbandjock women ages 15-50 were currently married; however, the latter district is characterized by widespread marital instability. The average number of pregnancies per women was 3.1 in Jakiri and 2.67 in Mbandjock, with average child wastage ratios of 0.43 and 1.12, respectively. The infant mortality rate in Jakiri was 147/1000 livebirths in 1976-77 and 137/1000 in 1977-78. The rate in Mbandjock declined from 417/1000 livebirths in 1976 to 0 in 1977, a decrease attributed both to an effective measles campaign and the small sample size. The average desired family size was 9 in Jakiri and 6 in Mbandjock. Jakiri demonstrated a total infertility rate of 17%. The corresponding rates in the 3 Mbandjock villages were 48, 46, and 52%. The proportion of infertile women ages 20-29 was 18% in Jakiri and 22, 16, and 24% in the Mbandjock villages. According to the World Health Organization, a 15% infertility rate in this age group is the limit for declaring a serious public health problem. However, since Careroon authorities seem satisfied with the fertility situation in Jakiri, it is suggested that the limit be raised to 18%. Mbandjock, on the other hand, is considered to have a serious infertility problem. 4 recommendations are made to improve the health profile for this part of rural Cameroon: 1) family planning programs should be introduced in areas of population explosion; 2) health education campaigns should be directed against the high rates of communicable diseases and childhood immunization campaigns should be introduced; 3) nutrition education should be integrated into community development programs; and 4) vital statistics collection should be centrally supervised.
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  6. 6

    Handbook on infertility.

    Kleinman RL; Senanayake P

    London, International Planned Parenthood Federation, 1979. 58 p.

    This International Planned Parenthood report states the agency's policy position on management of infertility, and then briefly goes on to cover the following topics, in handbook form: 1) epidemiology of infertility; 2) etiology of infertility; 3) proper infertility counseling; 4) prevention (trauma avoidance and early treatment of diseases); 5) diagnostic techniques for the couple, man, and woman; 6) treatment of infertility in women and men; 7) use of artificial insemination, both with donor's semen and partner's semen; and 8) the place of adoption within the community of infertile couples. Prevalence of infertility is placed at an international average of 10%, though places such as Cameroon have rates as high as 40%. The factors influencing infertility are divided into 3 groups: 1) socio-cultural, 2) sexually transmitted diseases, and 3) other diseases and disorders. Causes of female infertility include: ovulation dysfunction; tubal obstruction or dysfunction; uterine actors such as fibroids, polyps, or developmental abnormalities; cervical abnormalities; vaginal factors, such as severe vaginitis or imperforate hymen; endocrine and metabolic factors, particularly thyroid disturbances, diabetes, adrenal disorder, severe nutritional disorders (anemia), or other systemic conditions; and repeated pregnancy wastage. Male causes include poor semen quality; ductal obstruction; ejaculatory disturbances (i.e., failure to deliver sperm to vagina); emotional stress (may lead to hypogonadism); and genetic factors (Klinefelter syndrome). Causes specific to the couple include lack of understanding of reproductive physiology, immunoloigcal incompatibility, nutritional deficiencies, and psychogenic factors.
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  7. 7

    Design of studies for the assessment of drugs and hormones used in the treatment of endocrine forms of female infertility.


    In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 135-154

    The lack of uniformity in diagnostic selection of women for treatment of infertility, in choice of therapy, in monitoring of therapy, and in follow-up, frequently does not allow a meaningful comparison of results reported from different centers. To design studies assessing effectiveness of therapy of endocrine forms of female infertility, it is essential to consider: 1) mechanism controlling reproductive functions (e.g., process of ovulation); 2) cause(s) responsible for infertility (mechanical factors, ovarian failure, and pituitary failure); and 3) the mechanism of action of agents used for therapy (e.g., gonadotropins stimulate gonadal function, clomiphene stimulates gonadotropin secretion, and ergoline derivatives inhibit prolactin secretion). Patients selected for therapy should be grouped according to etiology: 1) hypothalamic-pituitary failure; 2) hypothalamic-pituitary dysfunction; 3) ovarian failure; 4) congenital or acquired genital tract disorder; 5) hyperprolactinemic patients with a space-occupying lesion in the hypothalamic-pituitary region; 6) hyperprolactinemic patients with no space-occupying lesion; and 7) amenorrheic women with space-occupying lesion. Ideally, an infertile couple should be diagnosed and treated as a unit.
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  8. 8

    The investigation of the infertile couple: a critique of the currently available diagnostic tests.


    In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 111-134

    A 6-month regimen for managing infertile men and/or women ideally forms 4 stages: 1) history and examination of the couple; 2) confirmation of ovulation, compatibility of sperm and mucus, and seminology; 3) tests for tubal patency; and 4) detailed endocrine tests for abnormalities found in Stages 1-3. Medical history should include emotional stress and work pressures, if any. Ovulation confirmation requires 2 tests combined from these 4: 1) basal body temperature; 2) endometrial biopsy; 3) blood progesterone levels; and 4) urinary pregnanediol. These procedures are outlined in detail, and figures chart body temperature variations and expected progesterone and pregnanediol levels. Assessment of cervical mucus and measurement of sperm penetration combine in vitro and in vivo tests. The Sims-Huhner test (postcoital test), though not standardized, is used to analyze sperm-mucus interaction by quantitative scoring of sperm count and motility. Other in vitro tests are the sperm-mucus match test and the fractional postcoital test (both described). Tubal patency is investigated by tubal insufflation with CO2, hysterosalpingography, endoscopy, and laparoscopy. Additional Stage 4 tests include vaginal cytology and assessment of estrogen and progesterone effects.
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