Risk factors of tubal infertility in a tertiary hospital in a low-resource setting: a case-control study
Authors: Egbe Thomas Obinchemti , Nana-Njamen Theophile , Elong Felix , Tchounzou Robert , Simo Andre Gaetan , Nzeuga Gaelle Padjip , Njamen Nana Cedric , Manka’a Emmanuella , Tchente Nguefack Charlotte , Halle-Ekane Gregory Edie 
Published: March 2020

Abstract
Background
Infertility is the inability to sustain a pregnancy in a woman with regular (2–3 times per week) unprotected sexual intercourse for a period of 1 year. This is a major public health problem that remains under-recognised in Cameroon and most countries in sub-Saharan Africa. This study aimed at identifying the risk factors associated with tubal infertility in a tertiary hospital in Douala, Cameroon.

Methods
We conducted a case-control study at the Obstetrics, Gynaecology and Radiology Departments of the Douala Referral Hospital from October 1, 2016, to July 30, 2017. We recruited 77 women with tubal infertility diagnosed using hysterosalpingography and 154 unmatched pregnant women served as controls. Data on socio-demographic, reproductive and sexual health, and radiologic assessments were collected using a pretested questionnaire. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 24.0. Logistic regression models were fitted to identify demographic, reproductive health factors, surgical, medical and toxicological factors associated with tubal infertility. The adjusted odds ratios (AOR) and their 95% confidence interval were interpreted. Statistical significance set at p < 0.05.

Results
Sixty-one per cent of respondents had secondary infertility. Following multivariate logistic regression analysis, respondents who were housewives (AOR 10.7; 95% CI: 1.68–8.41, p = 0.012), self-employed (AOR 17.1; 95% CI: 2.52–115.8, p = 0.004), with a history of Chlamydia trachomatis infection (AOR 17.1; 95% CI: 3.4–85.5, p = 0.001), with Mycoplasma infection (AOR 5.1; 95% CI: 1.19–22.02, p = 0.03), with ovarian cyst (AOR 20.5; 95% CI: 2.5–168.7, p = 0.005), with uterine fibroid (AOR 62.4; 95% CI: 4.8–803.2, p = 0.002), have undergone pelvic surgery (AOR 2.3; 95% CI: 1.0–5.5, p = 0.05), have undergone other surgeries (AOR 49.8; 95% CI: 6.2–400, p = 0.000), diabetic patients (AOR 10.5; 95% CI 1.0–113.4, p = 0.05) and those with chronic pelvic pain (AOR 7.3; 95% CI: 3.2–17.1, p = 0.000) were significantly associated with tubal infertility while the young aged from 15 to 25 (AOR 0.07; 95% CI: 0.01–0.67, 0.021), those in monogamous marriages (AOR 0.05; 95% CI: 0.003–1.02, p = 0.05), as well as those with a history of barrier contraceptive methods (condom) (AOR 0.17; 95% CI: 0.03–1.1, p = 0.06) were less likely to have tubal infertility.

Conclusion
The following factors were independently associated with tubal infertility: being a housewife, self-employed, history of Chlamydia trachomatis, Mycoplasma infection, and uterine fibroid. Furthermore, a history of pelvic surgery and other surgeries, diabetes mellitus, and chronic pelvic pain were also associated with tubal infertility. Young age, persons in monogamous marriages and users of barrier methods of contraception (condom) were less likely to have tubal infertility. Identification of these factors will be a target of intervention to avoid tubal infertility.