Infertility: an approach to management in a district hospital in Ghana
Fiander, A.
Tropical Doctor 20(3): 98-100
1990
ISSN/ISBN: 0049-4755 PMID: 2219439 DOI: 10.1177/004947559002000302Document Number: 370275
Up to 1/3 of women of child bearing age are infertile in certain African areas. Over 1000 patients registered at Bawku Hospital, Upper East Region, Ghana during an 18-month period, where a scheme for the investigation and treatment of infertile patients was established. The 5 main causes of infertility are: 1) tubal damage; 2) male factor; 3) anovulation; 4) uterine factor; and 5) unexplained. Special clinics are set up for infertility; outpatient staff are recruited. A preprinted questionnaire should be used for a uniform approach. The one used in Bawku is shown in the appendix. Health talks should be given. They should use the local language be at the right level, and use visual aids. In large clinics, numbers should be used to insure a 1st come, 1st served basis. A treatment protocol is important. When the patient 1st walks in, the infertility form is completed; appropriate investigations are done--hemoglobin, VDRL, seminal analysis, and cervical or high vagina swabs, and others--and the results are reviewed. The patient is encouraged to keep a menstrual calendar for 3 months. At the 2nd visit, the menstrual calendar is reviewed. A pelvic examination and a tubal patency test (TPT) are done. At the 3rd visit, abdominal and pelvic examinations are done and a TPT. Then patients can be diagnosed and counselled accordingly. At the last visit, further explanation is given, further TPTs are done if necessary, and anovulation is treated with clomiphene. The visits are spread out over 6 months. In unexplained fertility cases, the couple is told there is nothing wrong, they should keep trying. The idea that the man may be causing the infertility is foreign to many communities. This needs changing. 20% of infertility is due to male factor in Bawku. Male infertility is hard to cure. Cultural considerations prevent the clinician from telling the patient that her partner is infertile. They will tell her that there is nothing wrong with her. Approximately 15% become pregnant. The clinic has a strong psychological component.