Clinical Patterns and Major Causes of Male Infertility In Fallujah City

Abstract

Background: Infertility is one of a major public health problem, affecting 15% of couples who attempt pregnancy; in 50% of them, the male partner is responsible. Both environmental and genetic factors, combined or separated, have been suggested as indefinable causes of infertility. Idiopathic infertility represents 15-20% of all cases. Aim of the study: To determine the clinical patterns and to review the etiologies of infertility among men in Fallujah city and its periphery. Patients and method: Between the beginning of January 2006 to the end of December 2010, 1410 infertile men from Fallujah city were enrolled in this study. All patients were evaluated by history and physical examinations to show the testicular size, varicocele of spermatic cord, vas deferens abnormalities and secondary sexual characteristics. Investigations including seminal fluid analysis (after three days abstinence and not >7 days) were done to all patients, and assessed according to WHO criteria, while hormonal study was indicated only to those patients with severe oligospermia. Results: One thousand eighteen patients (72.2%) had primary infertility while 392 (27.8%) had secondary type. Patients with infertility of less than five years were considered in this study, which accounts 1222 patients only. Of those 1222 patients 878 (71.8%) had primary type and 344 (28.2%) had secondary type of infertility. Sperm count was categorized as (zero, ˂ five millions , 5-10 million, ˃ 10-19 million and ≥ 20 million). For all 1222 patients the distribution was 126 (10.3%), 78 (7.1%), 65 (5.3%), 72 (5.9%) and 872 (71 .4%) respectively. Among those with primary infertility the sperm count distribution was 112 (12.8%) , 71 (8.1%) , 51 (5.8%) , 57 (6.5%) and 587 (66.9%) respectively ,while those with secondary infertility the distribution was 14 (4.1%) , 16 (4.7%) ,14 (4.1%) , 15 (4.4%) and 285 (82.8%) respectively. The sperm motility in 854 (70%) was lower than normal (asthenospermia),among them, those with primary infertility the motility was low in 620 (70.6%) while those with secondary type 234 (68%) had low motility. Six hundreds thirty eight patients (53.2%) have identifiable causes for their infertility (history of trauma , inguinal operations ,mumps, smoking ,varicocele ,STD ,chemotherapy , chronic medical illness , radiotherapy ,and renal transplant), while 584 patients (47.8%) have non-identifiable causes of infertility. The mean of their age is 30.79 years ±7.09 SD and their duration of infertility between 1-5 years, with mean of 2.28± 1.23SD. Among those patients with non-identifiable infertility, 410 patients (70.2%) had primary infertility and 174 patients (29.8%) had secondary type. Conclusion: Non-identifiable infertility is high among infertile men in Fallujah city compared to the results of other neighboring countries and previous Iraqi studies. These results may be in a way or another related to military pollution occurred in Fallujah city during 2004 that herald the need of further investigations.