Causal Factors and Management Options of Infertility in Kuwait

Objective: To determine the main causes and management options of infertility in Kuwait. Methodology: Clinical evaluation, hormone profile of LH, FSH, prolactin and testosterone and midluteal phase progesterone, tubal patency tests, semen analysis and antisperm antibodies were assessed. Treatment included medical and surgical induction of ovulation. Male factor infertility was treated with antibiotics and immunosuppression when indicated, and empirically with antioxidants. Results: The main cause of female infertility was ovarian dysfunction (40.7%) with predominance of polycystic ovarian syndrome (52.9%), anovulatory regular cycles (25%) and hyperprolactinaemia (14.3%). Male factor accounted for infertility in 40.2% of the couples, with asthenozoospermia in 34.3%, oligozoospermia in 29.2% and azoospermia in 8.2%. Immuological tubal factors and endometriosis occurred in 9.8, 5.9 and 5.6%, respectively, and unexplained infertility in 8.5%. Both spouses were involved in 36.5% of the couples. Clomiphene citrate was the commonest agent for induction of ovulation with an 80% success rate. Bromocriptine, gonadotropins and laparoscopic ovarian cautery had success rates of 71, 69, and 80%, respectively. Treatment outcome in male factor infertility was variable. Conclusion: Ovarian dysfunction and male factor infertility are the dominant factors responsible for infertility in Kuwait. Induction of ovulation has a good prognosis of 40–80% success rate. Tubal factor infertility is uncommon in Kuwait.