Med. J. Cairo Univ., VoL 81, No. 1, March: 191-209, 2013 www.medicaljournalofcairouniversity.com Relationship between Using Hormonal Contraceptives, Intrauterine Device and Secondary Infertility ASMAA T. ABD EL-LATIEF, D.N.Sc.1; AHMED R. EL ADAWY, D.N.Sc.2; MANAL F. MOUSTAFA, D.N.Sc.3 and HAMIDA A. ABD EL HAFEZ, D.N.Sc.4 The Departments of Technical Institute of Nursing 1, Obstetrics & Gynecology Medicine2, Faculty of Medicine, Minia University and Obstetrics & Gynecology Nursing3,4, Faculty of Nursing, Assiut University Abstract Conclusion: The fmdings of the study clarified that I.U.D. and hormonal contraceptives can cause menstrual disorders Introduction: Infertility has been defined as failure to and other complications which can affect fertility. conceive after frequent unprotected sexual intercourse for one or two years. Secondary infertility defined as the inability Recommendations: There is a strong need for increasing to conceive despite exposure to pregnancy for one year (2 women awareness about various family planning methods years in some epidemiological studies), Infertility can be and its disadvantages to decide which one has the least side linked to several causes Family planning methods especially effects before using and how to avoid its complications. hormonal contraceptive methods which contain estrogen and Key Words: Infertility — Family planning — Contraceptives — progestin or progestin only such as are safe and reliable way IUD. to prevent pregnancy for most women but some of them are long acting and fertility may not return for up to 18 months Introduction after being stopped. Intrauterine contraceptive devices can increase the risk of STD's, uterine cancer and upper reproduc- REPRODUCTIVE choices include not only the tive tract infection (RTIs) women which results in serious ability to avoid unwanted childbearing but also consequences, such as pelvic inflammatory disease (PID) and adhesions which lead to infertility so in this study the researcher the possibility of bearing wanted child. The pre- tried to identify to what extent the contraceptive methods can vention, diagnosis and treatment of infertility, the affect fertility. inability to bear children-are the fore and essential part of ensuring reproductive choice [ii. Aim of this Study: Was to determine the relationship between using hormonal contraceptives, intrauterine device Infertility has been defmed as failure to conceive and secondary infertility. after frequent unprotected sexual intercourse for Material and Methods: Correlational design was used in one or two years. Secondary infertility defined as this study. Three hundred women were recruited for the study, the inability to conceive despite exposure to preg- they were divided into two groups included 150 women in nancy for one year (2 years in some epidemiological each (group B) suffering from secondary infertility and (divided into 75 women were using I.U.D. before and 75 were using studies), after having not necessarily have a living hormonal contraceptives and 150 group A (women suffering child [2]. Infertility affects approximately 10-15% from secondary infertility and didn't use any contraceptives of couples of reproductive age, it's prevalence has before). Data was collected from obstetric, gynecology and been stable during the last past 50 years, although pediatric university hospital and infertility center in Minia a shift in etiology and in the age of the patient city. It was carried out in the period from October 2011 to October 2012, using structured interviewing sheet which population has occurred. The average prevalence included: Sociodemographic data, complete history taking of infertility estimated to be 5.5%, 9.4% and 19.7% regarding menstruation, obstetrical history, and family plan- respectively at ages 25-29 years, 30-34 years and ning, medical and surgical history. 35-39 years [3]. Female infertility account for 35% Results: The study revealed statistically significant dif- of infertility. The prevalence varies between regions ferences (p<0.05) among groups in most items regarding and countries. Its pattern is different in developed menstrual and obstetrical history and causes of terminating countries than those in developing regions of the the method which are linked to secondary infertility. world. In developed countries, between 8 and 12% of all couples, experience some form of infertility Correspondence to: Dr. Hamida A. Abd El Hafez, during their reproductive lives. In developing The Department of Obstetrics & Gynecology Nursing, countries where the incidence of reproductive tract Faculty of Nursing, Assiut University infection is high, infertility rates are much higher 191 192 Relationship between Using Hormonal Contraceptives which in many instances preventable. Infertility reproductive tract infection (RTIs) in women result affects about 6 1 million people in the United States in serious consequences, such as pelvic inflamma- (U.S.), about 10% of men and women of reproduc- tory disease pelvic inflammatory disease (PID) tive age [41. and adhesions, resulting in infertility [12]. Globally infertility affects about 50 to 80 millio Family planning methods especially hormonal ncouples at some point to their reproductive lives contraceptive methods which include (oral pills, with a variety of biological and behavioral deter- skin patch, injectable Depo-Provera, and a ring minants In developed countries, between 8 and worn in the vagina) can lead to secondary infertility. 12% of all couples experience has some forms of Hormonal methods of birth group Acontain estrogen infertility during their reproductive lives. In devel- and progestin, or progestin only, and are a safe and oping countries where the incidence of reproductive reliable way to prevent pregnancy for most women tract infection is high, infertility rates are much but some of it is long acting and fertility may not higher which in many instances are preventable return for up to 18 months after being stopped [6]. [51. A study that was done in Kafer Elsheikh in Egypt to assess the prevalence of infertility in rural areas For millions of couples around the world, the it showed that; 7.9% of women reported secondary inability to have children is a personal tragedy. infertility and 2.5% experienced primary infertility, The accompaniment of personal, interpersonal, the prevalence of primary infertility is higher social, and religious expectations brings a sense among women under 30 years than older ages, and of failure, loss, and exclusion to those who are secondary infertility increases with advance in age. infertile [6]. Both types of infertility were higher among women Infertility has increased as a problem over the married under the age of 16 or above 30 years [13]. last 30 years all over the world, regarding to social phenomena, such as the tendency for marriage at Significance of the study: a later age and child bearing, increasing use of Worldwide more than 70 million couples suffer contraception specially Intra Uterine Device (IUD) from infertility, the majority being residents of and abortion. It is a significant public health prob- developing countries. Infertility represents a na- lem with serious social consequences [7]. tional health problem in Africa, affecting10-32% of couples on average Men and women are affected Infertility represents a national health problem by infertility in different ways. Most couples ex- in Africa, affecting 10-32% of couples on average perience the struggle in much the same way. This [8]. Low rates of primary (4,3%) and high rates of is related to the traditional ways men and women secondary infertility (5-23%) could be attributed have been trained to think, feel and act. That men to higher rates of STI-induced infertility [9]. and women can help each other balance thinking The impact of infertility varies in different and feeling as they struggle side by side on their cultures. In communities that are more primitive, journey toward parenthood [14]. the concern about infertile marriage is intense. Egypt is considered one of the developing world Infertility in these communities is taken as displea- in which the prevalence of secondary infertility is sure and a cause of divorce. In our culture as a also high, experiencing rates between 15 and 20% reason for a second marriage or even rarely for [15].A study was conducted in Assuit University suicide. Infertile individual in Upper Egypt is Hospital about infertility in 2006 and it revealed described as functionless person. For the male, it that (22.2%) of women had secondary infertility is a disgrace and stigma of masculinity he is equated [16].The changes in the demographic pattern over to a female [101. the past 30 years in Egypt (the shifting from the Infertility can be linked to several causes. These first face to the end of the second face of the causes have been discussed in several studies such demographic transition) made the problem of in- as ovarian factors, bilateral tubal obstruction, fertility more urgent [13]. Causes for secondary uterine factors, cervical factors, and hormonal infertility are several; so in this research we try to factors among the most common causes reported identify if hormonal Contraceptives and intrauterine are reproductive tract infections (RTIs) [iii. device can be risk factors for secondary infertility. Intrauterine contraceptive devices (IUDs) are Aim of the study: widely used all over the world. IUD use can in- Was to assess the relationship between using crease the risk of sexual