Epidemiology and Health Related Quality of Life in Infertile Females

Abstract

Introduction Infertility is a major problem for persons who suffer from this condition. It has numerous effects on couples but its effects are more pronounced on females than males especially in developing countries like Egypt. Social and psychological effects are profound. Limited resources even worsen the problem and there is little or no governmental support or insurance coverage.

Aim This research aimed to study epidemiology and identify the main risk factors associated with infertility among Egyptian females, assess the health related quality of life among these patients including physical, psychological and social domains, and estimate the economic burden of treatment.

Methodology Subjects were obtained from two tertiary care hospitals in Cairo and were interviewed about relevant risk factors, health related quality of life and economic effects of infertility. Data was collected through an interview questionnaire developed by the researcher covering the previously mentioned areas . 918 females were interviewed, 468 cases and 450 controls. The answers of the two groups were compared for statistical significance. Results Main results showed age at marriage, increased body mass index, alcohol intake, exposure to x-ray, exposure to radiotherapy, exposure to lead, exposure to chemicals, exposure to domestic pesticides, to be significant risk factors for infertility. Infertile females were more liable to being married a second time. Also infertile females were more liable for their husband to have another wife. There was no significant difference between both groups as regards place of residence, education and employment. Infertile females showed a significantly higher percent having history of congenital malformations, family history for hereditary disease, and abnormal pattern of menstruation.

Logistic regression found predictors of infertility to be: age at marriage less than 16or more than35, married more than once, husband has another wife, has college degree or more, exposure to x-ray, exposure to radiotherapy and abnormal menstrual history. This model explained 73.4% of the variability among cases in the study.

Infertile females showed worse scores than fertile females on all domains of quality of life especially the psychological domain. But the two groups had very close scores when they were asked about the total score of their QOL. A more in depth study of infertile females showed the following. Infertile females aged less than 30 had worse scores in the physical domain. Infertile females experiencing a second marriage had better scores in the physical domain. Infertile females with primary infertility had worse scores in the psychological and social domains.

Regarding the economic burden of infertility, nearly 49% of patients reported they need financial support to continue treatment. Almost 52.1% of patients had income ranging from 500 to less than 1000 EGP. Governmental support and insurance coverage were found in only 5% of cases.

Conclusions and recommendations This study concluded that infertility in Egypt represents a burden on infertile females in many ways; physically, psychologically, socially and economically. There are numerous risk factors for the condition many of which can be prevented. Providing economic support for these patients should be taken into consideration. This special group of females needs special caretailored to individual needs. Medical personnel should be trained to be able to provide appropriate counseling for this group of females.