Infertility in Saudi Arabia: Initial Experience in a New Gynaecological Unit

The etiological factors in patients complaining of infertility were investigated at the Riyadh Military Hospital in Saudi Arabia. A retrospective analysis of the 70 patients attending the gynecological clinic and seen by 1 consultant were made to determine any specific factors relating to their infertility. 41 (58.6%) of the patients complained of primary infertility, and 29 (41.4%) complained of secondary infertility. 4 case notes were not retrieved, leaving 37 case notes for analysis with primary infertility. 3 case notes were not retrieved in cases of secondary infertility, leaving 26 for analysis. 2 patients had proven syphilis in the primary infertile group, but tubal pathology was not necessarily high (13.5%) and a broad spectrum of pathology was found to be similar to a UK population. 13 primary infertile patients had had raised prolactin levels and were eligible for bromocriptine therapy. Thus far, 6 patients have received it. The analysis of the secondary infertile patients showed a high incidence of anovulation, although the prolactin levels remained in the more normally accepted range and, at the time of the study, only 1 patient was receiving bromocriptine therapy. Unsuspected endometrial tuberculosis was diagnosed in 1 case in the secondary infertile group (and generalized tuberculosis was known in 1 case in the primary infertile group), tuberculosis remains a high possibility as en etiological factor. Schistosomiasis was considered as an etiological factor but was not found in any of the gynecological patients and only 2 cases of genital schistosomiasis were detected in Riyadh between 1964-67. 3 of the husbands in the secondary infertile group had an abnormal semen analysis, and 8 of the husbands in the primary infertile group also had abnormal counts. Several analyses showed an unusually high incidence of pus cells and asymptomatic bacteriospermia has been shown to be associated with infertility. Antibiotic therapy was thus indicated with repeat semen analysis in the management of such infertile patients. Further stuides are indicated to determine the number of patients attending the primary care, surgical, and medical clinics for investigation of male infertility. A number of male patients with schistosomiasis are attending the Primary Care Department for investigation and treatment.