Tertiary Care for Infertile Couples: Etiological Diagnosis and Conventional Treatment Outcomes in Kisangani, Democratic Republic of the Congo

Abstract

Background In sub-Saharan Africa, tubal factors are described as the main etiological factor of infertility. Under these conditions, medically assisted procreation is particularly indicated. However, ART centers are less available. Thus, infertile couples are quickly oriented towards available conventional alternative treatment. The present study aimed to determine the etiological factors of infertility, the outcomes of the therapeutic options offered, and the factors associated with the success of conventional treatment in infertile couples seeking tertiary care in Kisangani.Methods a cross-sectional study was conducted in two tertiary-level health facilities in Kisangani. Consented infertile couples underwent specific examinations necessary for the exploration of infertility and were treated and followed for a minimum of 6 months. The therapeutic option to be offered could relate to the expectant attitude, medical treatment, surgical treatment or transfer to an in vitro fertilization unit. The pregnancy diagnosis was done by ultrasound.Results A total of 272 infertile couples underwent specific examinations, then were treated and followed for a minimum of 6 months. Many determinant causes are mostly linked to wives than husbands. Overall, only 34 women among 211 treated got pregnant during the follow-up period; 61 couples were advised to resort to IVF or adoption, but the couples for whom the expectant attitude was indicated, had immediately rejected it. The patients who therapeutically succeeded at the end of the treatment were those whose age was less than 35 years (OR = 2.27; 95% CI = 1.06–4.87; P = 0.017), the duration of infertility was less than five years (OR = 6.08; 95% CI = 1.79–20.69; P = 0.001) and those with secondary infertility (OR = 6.08; 95% CI = 1.79–20.69; P = 0.001).Conclusion The etiological particularities, with the predominance of tubal factors, do not allow extend effective treatment without ART techniques. This study constitutes a genuine plea to stimulate national policies to take an interest in infertility questions.