Medical Characteristics and Therapeutic Approaches Used to Treat Primary and Secondary Infertile Women
Background: Inability to conceive is a major problem during reproductive age. This study aimed to describe medical characteristics and different approaches to get better the management of infertility among women referring to some public and private health centers in Morocco.
Methods: Overall, 619 infertile women referring to public and private health centers in Marrakech-Safi region were selected by simple random sampling method, between 1 Oct 2013 and 31 Dec 2015. The socio-economic data, demographic characteristics, medical and obstetric variables and types of infertility treatments were simultaneously collected by questionnaire and health record data. The univariate logistic regression analyses were used to determine different infertility treatments. Statistical significance was set at 0.05.
Results: The rate of primary and secondary infertility was 67.37%, and 32.63%, respectively. In comparison to secondary infertility, primary infertile women with high socio-economic level and low average age have used many fertility drugs and assisted reproductive technologies (Clomifene citrate (45.01 vs. 29.20%), injectable gonadotropins (09.35 vs. 3.96%), dydrogesterone (35.08 vs. 23.26%), intrauterine insemination (3.83 vs. 0.49%), and in-vitro fertilisation (3.11 vs. 1.48%)).
Conclusion: The use of infertility’s treatment is limited in Morocco. Outside of medical coverage, the infertility management requires permanent efforts, financial supports, psychological assistance and serious dialogue between all the stakeholders.
2. Araoye MO (2003). Epidemiology of infer-tility: social problems of the infertile cou-ples. West Afr J Med, 22(2):190-196.
3. Boivin J, Bunting L, Collins JA, Nygren KG (2007). International estimates of infertili-ty prevalence and treatment-seeking: po-tential need and demand for infertility medical care. Hum Reprod, 22(6):1506-12
4. Dankert T, Kremer JAM, Cohlen BJ et al (2007). A randomized clinical trial of clomiphene citrate versus low dose re-combinant FSH for ovarian hyperstimu-lation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod, 22(3):792-797.
5. O'Brien YM, Ryan M, Martyn F, Wingfield MB (2017). A retrospective study of the effect of increasing age on success rates of assisted reproductive technology. Int J Gynaecol Obste, 138(1):42-46
6. Piette C, de Mouzon J, Bachelot A et al (1990). In-vitro fertilization: influence of women's age on pregnancy rates. Hum Reprod, 5(1):56-59
7. Homburg R (2005). Clomiphene citrate—end of an era? A mini-review. Hum Re-prod, 20(8):2043-2051.
8. Van Voorhis BJ (2006). Outcomes from as-sisted reproductive technology. Obstet Gy-necol, 107(1):183-200
9. Fauser BC, Diedrich K, Devroey P (2008). Predictors of ovarian response: progress towards individualized treatment in ovula-tion induction and ovarian stimulation. Hum Reprod Update, 14(1):1-14.
10. Tummon IS, Asher JL, Martin JS, Tulandi T (1997). Randomized controlled trial of superovulation and insemination for in-fertility associated with minimal or mild endometriosis. Fertil Steril, 68(1):8-12.
11. Legro RS, Barnhart HX, Schlaff WD et al (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syn-drome. N Engl J Med, 356(6):551-566.
12. The Practice Committee of the American Society for Reproductive Medicine (2008); Use of exogenous gonadotropins in anovulatory women: a technical bulletin. Fertil Steril, 90(5):S7-S12.
13. Viniker DA (1996). Infertility: Late luteal phase dydrogesterone in combination with clomiphene or tamoxifen in the treatment of infertility associated with ir-regular and infrequent menstruation: en-hancing patient compliance. Hum Reprod, 11(7):1435-1437.
14. Jain T (2006). Socioeconomic and racial dis-parities among infertility patients seeking care. Fertil Steril, 85(4): 876-881.
15. Devroey P, Fauser BCJM, Diedrich K (2009). Evian Annual Reproduction (EVAR) Workshop Group 2008. Ap-proaches to improve the diagnosis and management of infertility. Hum Reprod Update, 15(4):391-408.
16. Wilcox AJ, Weinberg CR, Baird DD (1995). Timing of sexual intercourse in relation to ovulation—effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med, 333(23):1517-1521.
17. Bokaie M, Simbar M, Ardekani SMY (2015). Sexual behavior of infertile women: a qualitative study. Iran J Reprod Med, 13(10):645-56.
18. Huyghe E, Bonal M, Daudin M, Droupy S (2013). Sexual dysfunctions and infertility. Prog Urol, 23 (9), 745-751.
19. Keskin U, Coksuer H, Gungor S et al (2011). Differences in prevalence of sexu-al dysfunction between primary and sec-ondary infertile women. Fertil Steril, 96(5):1213-17.
20. Chiaffarino F, Baldini MP, Scarduelli C et al (2011). Prevalence and incidence of de-pressive and anxious symptoms in couples undergoing assisted reproductive treatment in an Italian infertility depart-ment. Eur J Obstet Gynecol Reprod Biol, 158(2):235-241.
Copyright (c) 2018 Iranian Journal of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.