African Journal for Infertility and Assisted Conception

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Background: Male factor infertility is a global health issue that requires further studies to understand its magnitude, especially in developing countries, where the woman is usually blamed for the couple's infertility. Objectives: This study aimed to determine the patterns of male infertility in a teaching hospital in Ghana. Methodology: This was a prospective study of 110 male patients who presented with infertility at the urology outpatient clinic of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, from January 1, 2014, to December 31, 2017. Results: One hundred and ten men reported for the treatment of infertility over the study period. The mean age was 38.5 ± 7.4 years. The majority (58.2%) had primary infertility while the remaining 41.8% had secondary infertility. Four (3.6%) of the men had unilateral or bilateral cryptorchidism while 41 (38.7%) of those with both testes resident in the scrotum had small-sized testes. Varicoceles were present in 24 (22.6%) men, 58.3% of whom had primary infertility while the remaining 41.7% had secondary infertility. Thirty-eight (34.5%) of patients had low semen volume was seen in 38 (34.5%) patients. Azoospermia was seen in 28 (25.5%) patients with 30 (27.3%) patients having no motile spermatozoa. Conclusion: Male infertility in Ghana should receive more recognition, and male participation in reproductive health programs should be encouraged.

Background: Seminal fluid analysis (SFA) is the most important investigation of the infertile males but limited in revealing the etiologies of the various spermatozoa abnormalities observed on microscopy. Increasing prevalence of male infertility and the challenges of diagnosis require biochemical investigations such as reproductive hormonal profile. Aims: The aim of this study is to determine the reproductive hormonal profile patterns among infertile males in Ilorin. Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: A total of 130 male partners of infertile couples served as subjects and 50 fertile males as controls. Serum reproductive hormonal assay was done using ELISA method. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA) was used. Normally distributed data were expressed as mean ± standard deviation. Results: The mean age of the subjects who were majorly civil servants was 38.6 ± 6.6 years. The prevalence of reproductive endocrinopathies in this study was 46.9%. Mean serum concentrations of follicle-stimulating hormone, luteinizing hormone, and prolactin were elevated in our subjects than control. Mean serum testosterone concentration was significantly lower in our infertile subjects. Patterns of hormonal profile abnormalities among our subjects were 2 (1.5%) with hypogonadotropic hypogonadism, 15 (11.5%) with hypergonadotropic hypogonadism, 23 (17.7%) with hypergonadotropic normogonadism, 21 (16.2%) with normogonadotropic hypogonadism, and 69 (53.1%) with normogonadotropic normogonadism. This showed 59 (45.4%) subjects with primary testicular failure/resistance and 2 (1.5%) with secondary testicular failure. Twenty (15.4%) of the subjects had hyperprolactinemia. Conclusions: Reproductive hormonal profiling of male partners of infertile couples is an important adjuvant to SFA, in diagnosis and monitoring responses to treatment.

Molar gestation, with its attendant risk to progress to frank choriocarcinoma, has been reported in the literature. It can follow both spontaneous and assisted conceptions. With the growing popularity of assisted conception techniques for the management of infertility in our setting, it is important to bring to the fore that similar complications could occur and hence should inform the counseling of patients before and during such procedures. We present a 39-year-old nullipara who had in vitro fertilization and frozen embryo transfer. Eight weeks later, she was diagnosed with missed abortion and had manual vacuum aspiration at a private hospital in Zaria. Histopathological examination revealed partial hydatidiform mole, and she was subsequently managed at a tertiary health center in Zaria with six cycles of methotrexate chemotherapy because she was low risk based on the International Federation of Gynecologists and Obstetricians criteria. She was monitored with monthly serum beta-human chorionic gonadotropin (β-HCG) and was placed on combined oral contraceptive pills. The serum β-HCG levels fell to almost undetectable levels and remained so after four cycles of the chemotherapy regimen. Molar pregnancy can follow assisted conception in our environment. This underscores the importance of pretransfer cytogenetic and histopathological assessment of any specimens aspirated following every incomplete/missed abortion. This case also brings to the fore the importance of referral of similar cases to higher levels of care for expert/multidisciplinary management.

Infertility is a major public health problem and imposes major physical and psychological burden to couples as well as to their relatives. Infertility due to the absence of uterus can be difficult to manage and could even be more challenging in our environment where couples insist on having children with their own genetic component. We present a case of a 35-year-old married graduate trader with primary infertility of 7-year duration due to Mullerian dysgenesis. She had a successful surrogacy.

Background: Transvaginal ultrasound-guided oocyte retrieval (TUGOR) technique is minimally invasive and requires shorter time compared to previous techniques. Yet, it is a potentially stressful and painful procedure and thus requires some form of analgesia with or without sedation. The effects of various anesthetic techniques used for TUGOR on reproductive outcomes remain controversial. Aims and Objectives: This study aimed at comparing the efficacy of paracervical block (PCB) and conscious sedation for pain relief and pregnancy outcomes during TUGOR. Materials and Methods: This is a cross-sectional comparative study of 137 eligible clients that underwent assisted reproduction program in our facility. All clients were treated with antagonist protocol for controlled ovarian hyperstimulation. The choice of analgesia for TUGOR was influenced by clients' and/or clinicians' preference. PCB and conscious sedation were administered for TUGOR in 66 and 71 clients, respectively. Pain was assessed using a 10-cm Visual Analog Scale (VAS), while clients' overall satisfaction was rated using Likert scoring system. Results: There was no statistically significant difference in the clinical pregnancy, miscarriage, and live birth rates between the two groups. The mean VAS 10-point scores at 1, 6, and 24 h postretrieval and on the day of embryo transfer were significantly higher for paracervical group. The mean Likert score for conscious sedation group was significantly higher than that of paracervical group. Conclusion: Conscious sedation is superior to PCB as anesthetic/analgesic agent for pain relief and clients' satisfaction for TUGOR. However, a multimodal approach to anesthesia/analgesia for TUGOR is suggested to further improve overall clients' satisfaction.

Online since 12^th Aug, 2016