Infertility is the inability to achieve pregnancy after one year of regular, unprotected sexual intercourse. A thorough history and physical examination for both males and females can uncover one or more causes and indicate the need for further investigation [1]. Contributing variables related to males account for 24% of the overall causes. Ovarian dysfunction, tubal factors, unexplained reasons, and other variables contribute to infertility, with respective proportions of 21%, 14%, and 28%. The percentage is 13% [2]. Infertility manifests in three different forms. Primary infertility refers to a woman's inability to conceive and bear a child. This situation might arise when a woman experiences infertility or is unable to sustain a pregnancy for its entire duration. Therefore, women who have never experienced childbirth and who experience spontaneous miscarriages would exhibit primary infertility. Secondary infertility refers to the condition when a woman is unable to conceive after previously having a successful pregnancy, the ability to carry a pregnancy to term, or the inability to become pregnant at all. Thus, if a woman who has previously been pregnant or capable of becoming pregnant experiences a spontaneous miscarriage or stillbirth, she is unable to carry a baby to full term successfully and would exhibit secondary infertility [3]. Sterility refers to a complete inability to become pregnant, whereas infertility refers to a reduced ability to conceive. Couples without children, where the female partner is under the age of around 43 and facing challenges in getting pregnant, are often categorized as infertile rather than sterile [4].

Infertility can affect both men and women. In less developed countries, it is culturally acceptable for a husband to seek a divorce based on infertility; research undertaken by the World Health Organization (WHO) examined 5800 couples experiencing infertility who sought help at 33 medical centres in 22 developed and developing countries. The study found that in more than 50% of these couples, men were either the primary cause or a contributing factor to infertility; typically, female variables had a role in around 25% to 37% of infertility cases worldwide, whilst male factors were responsible for approximately 8% to 22%. The combined influence of both male and female variables contributed to around 21% to 38% of infertility cases [5].

Various research was conducted to assess infertility at Al-Batool Teaching Hospital in Baqubah City. One of these studies examined the correlation between infection and infertility in patients residing in Baqubah City. The study found that the incidence of infertility among women in Baqubah City was 22.7%. The prevalence of primary infertility was 69.60%, whereas secondary infertility accounted for 30.40% of the cases; most individuals, including 65.7% of the total, experienced infections caused by Trichomonas vaginalis, Candida albicans, and Chlamydia [6]. Contrary to other studies, study findings indicate that obese pregnant women residing in metropolitan areas had a statistically significant higher likelihood of experiencing a miscarriage; the study advised women to reduce their weight before pregnancy in order to prevent this issue [7]. Previous research has identified a gap in understanding the factors contributing to infertility in patients seeking treatment in Al Batool Teaching Hospital's infertility unit. Specifically, there needs to be more information regarding the number of women seeking consultation at the hospital, their demographic characteristics, and the underlying causes of their infertility. Our study aims to address this gap by determining the number of women who sought consultation at Al-Batool Teaching Hospital during 2013, 2014, 2015, and June 2016. Additionally, we will describe the demographic characteristics of these patients and identify the specific causes of their infertility. 

Patients and Methods

This study is a cross-sectional analysis of 200 patients who saw doctors at Al-Batool Teaching Hospital's infertility clinic between January 1, 2013, and June 30, 2016. Over the course of four months, data were collected from the infertility unit once each week using a questionnaire designed expressly to gather patient information.

Study Tools

Data gathering was performed by collating questions and corresponding responses from the records of infertility units within the hospital. In addition, a questionnaire was given to collect data on age, place of residence, occupation, type of infertility, causes of infertility, length of infertility, and blood groups. Each response was examined using a table to assess the influence of each factor. This study included all patients, regardless of gender, who sought consultation at the infertility unit for the purpose of achieving pregnancy or addressing hormonal issues. Patients without infertility or those who were currently pregnant were excluded based on certain criteria. 

Research Ethics

The study obtained approval from the Medical Faculty at the University of Diyala, Baqubah. Data for the questionnaire was obtained with the patients' agreement.

Statistical Analysis

The data analysis was conducted utilizing a computer and SPSS (Statistical Packages for Social Sciences) [8].

Study results reveled: 

Gender Distribution

During the study period, there were a total of 200 patients diagnosed with infertility. Among them, 184 (92%) were females and 16 (8%) were men, as indicated in Table 1. These findings suggest a potential connection between male perception of fertility and their sense of masculinity. Some men may feel that a decrease in sperm count or poor sperm quality diminishes their sense of manhood. Consequently, they may experience intense emotions of guilt, anger, and low self-esteem, which can have a significant impact on various aspects of their lives. This outcome contradicts the findings of a study conducted by Wallin, H. in 2012 [9].

Table 1: Gender Distribution among the Patients in the Sample Population

Age Distribution

The prevalence of female infertility was predominantly observed in individuals aged 21 to 30, with a total of 120 reported cases. Among the observed cases, 65% occurred in individuals aged 31 to 40, totaling 59 cases. In males, infertility was primarily observed in the age range of 31 to 40, with a total of 9 occurrences. According to Table 2, individuals aged 21 to 30 accounted for 56% of the cases, while the remaining 44% can be attributed to the decline in fertility with increasing age in both males and females. These findings are consistent with the results reported by Sherman, J in 2000 and Lisha, D in 2011 [10,11].

Table 2: Patients' Age Representation in the Sample Population

Residency Distribution

With respect to residency, the majority of the patients were urban dwellers, including 62% females and 56% men. On the contrary, the percentage of female patients in rural areas is 38% and the percentage of male patients is 44%, as indicated in Table 3. The disparities in fertility rates between urban and rural areas could be attributed to both actual residence effects and population composition. The urban effect is a reflection of urban societal norms, such as delayed marriage, as well as the opportunity costs associated with education and employment. Additionally, access to family planning services plays a role in these differences. These findings align with the results obtained in a study conducted by Michael, J in 2008 [12].

Table 3: Patients Categorized by Place of Residence

Occupation Distribution

Out of a total of 179 female patients, a significant majority of 81% (144 individuals) were unemployed, whilst the remaining 19% (35 individuals) were employed. However, it is important to note that all male patients (100%, 16 out of 16) in the study were employed, as shown in Table 4. This finding contradicts the results of previous studies conducted by Datta J et al. in 2016 and Baranski in 1993 [13,14]. This gap may arise from the prevalence of housewives among Iraqi females, with a minority engaged in job or education (35%, 19% respectively).

Table 4: Patients Categorized by their Occupation

Types of Infertility

The frequency of primary infertility among females was 68%, with 126 cases, while secondary infertility accounted for 32%, with 58 cases. Among men, a complete absence of fertility, known as primary infertility, was reported in all 16 cases, representing 100% of the sample. The findings are displayed in Table 5, these results are more pungent compared to the results of a study conducted by Al-Turki HA in 2015 and Paul et al. in 2013 [15-16].

Table 5: Classification of Patients based on Kinds of Infertility

Causes of Infertility

The main reason for infertility was found to be related to female factors, accounting for 92% (184 cases), while male factors accounted for 8% (16 cases), as shown in Table 6. In several countries, one-third of infertility cases are caused by female factors, another one-third is caused by male factors, and the remaining one-third could be due to issues with both partners or unexplained causes, which are often associated with feelings of shame and embarrassment [9].

Table 6: Classification of Patients based on the Etiology of Infertility

Diagnosis

Polycystic ovary syndrome (PCOS) was present in all female patients (184, 92%), whereas hypogonadism was identified in all male patients (16, 8%), as stated in Table 7. The acquired result is comparable to the findings of Mokhtar et al. in Egypt [17] and Najem F in Libya [18], as well as Pembe in Tanzania [19], These results may be linked to PCOS, which is regarded as a prominent risk factor associated with primary infertility.

Table 7: Distribution of Patients by Diagnosis in their Recorder

Duration of Infertility

Within the female group, 55% of patients sought consultation at the infertility unit within 1-3 years, 24% sought consultation within more than 3-6 years, and 20% sought consultation after 6 or more years. In the male group, 62.5% of patients sought consultation at the infertility unit within more than 3-5 years, while 37.5% sought consultation after 6 or more years, as indicated in Table 8. This result is consistent with the findings of Iswarya S. and Luke B. [20,21], which found a negative link between the length of infertility and the success of assisted reproductive methods, like the rate of pregnancy and live birth.

Table 8: Patient Distribution by Infertility Duration in Examined Groups

Blood Group

Among the female patients, 62% possessed blood type O, 21% possessed blood type B, and 15% possessed blood type A. Among the male patients, 75% had blood group O, whereas 19% had blood group B. These percentages are shown in Table 9. The results of this study are consistent with the research conducted by Khan MS et al., in [22] in Pakistan. This earlier study demonstrated a notable association between blood group O and infertility. 

Table 9: Distribution of Patients by Blood Group

This result could be attributed to the high incidence of blood category O among the population. However, the  results of this study differ from those of a study conducted by Wang L. et al. in 2015 [23] in India, which found no significant association between blood group and infertility.

The individuals who sought medical advice from the infertility department at Al Batool Teaching Hospital are included in Table 10.

Table 10: Number of Patients Attending the Infertility Unit during 2013, 2014, 2015 And 2016

The study findings indicate that the prevalence of infertility in both males and females in our community (Diyala) is comparable to that observed internationally. Additionally, infertility rates are higher among younger age groups and more prevalent in urban regions compared to rural ones; primary infertility is a prevalent condition, with polycystic ovary syndrome being the leading cause among females; more individuals, both males and females, have their blood type recorded as O; there was no correlation between the occupation, duration of infertility, and the occurrence of this illness in both males and females.

Acknowledgements

The Medical Faculty at the University of Diyala, Baqubah, granted approval for this study. We express our gratitude to the participants, coordinators, and data collectors who provided assistance during the study.

Financial support and sponsorship

self-funded 

Conflicts of interest

There are no conflicts of interest

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