Lessons learned from infertility investigations in the public sector.

OBJECTIVESTo determine the main factors causing infertility in an urban, tertiary hospital population. To establish if any such major causal factor could be used to rationalise and improve the service for infertile couples in the public sector.DESIGNA retrospective analysis of the hospital records of 206 women who had a tubal patency test (hysterosalpingogram) performed and the results of the investigations performed in the couples with infertility.RESULTSOf the 206 women 38 (18.5%) had normal fallopian tubes on hysterosalpingogram; 33 (16%) had unilateral obstruction and 135 (65.5%) had bilateral tubal obstruction. Of the latter group 81 (60%) had significant hydrosalpinges. Semen analysis results in 148 partners (71.8%) demonstrated a normal count in 85 (62%), normal motility in 70 (51%) and normal morphology in only 25 (18%). Testing for ovulation (mid-luteal phase progesterone) was positive in 91 of 124 women tested (73%). Compliance, technical and logistical problems were encountered with both semen analysis and mid-luteal phase progesterone tests.CONCLUSIONSInfertility is a major problem in South Africa, with limited resources for investigation and treatment in the public sector. Tubal factor infertility was the most common cause of infertility demonstrated in this study. In the presence of bilateral tubal obstruction with hydrosalpinges the prognosis is so poor that unless assisted reproductive techniques are available and affordable, further infertility investigations do not seem justified. Recommendations on an approach to the infertile couple in the public sector is outlined.