Table (1): Distribution of study participants according to their socio-demographic characteristics, Women Hospital-Hamad Medical Corporation, 2018
Sociodemographic
|
Cases
|
Cases
|
Controls
|
p value
|
Primary Infertility
n = 43 (%)
|
Secondary Infertility
n = 93 (%)
|
Infertility Total
n = 136 (%)
|
n = 272(%)
|
Age group:
- 16 - 25 year
- 26 - 35 year
- > 35 year
Mean + SD
|
12 (27.9)
23 (53.5)
8 (18.6)
29.4 + 6.7
|
12 (12.9)
43 (46.2)
38 (40.9)
33.9 + 6.0
|
24 (17.7)
66 (48.5)
46 (33.8)
32.5 + 6.6
|
59 (21.7)
164(60.3)
49 (18.0)
30.2 + 5.5
|
0.002*
|
Educational level:
- Illiterate
- Primary
- Preparatory
- Secondary
- University / higher
|
1 (2.3)
6 (14.0)
1 (2.3)
17 (39.5)
18 (41.9)
|
5 (5.4)
4 (4.3)
11 (11.8)
40 (43.0)
33 (35.5)
|
6 (4.4)
10 (7.4)
12 (8.8)
57 (41.9)
51 (37.5)
|
2 (0.7)
13 (4.8)
13 (4.8)
131(48.2)
113(41.5)
|
0.028*
|
Average household monthly income:
- < 12.000 QR
- 12.000-<25.000 QR
- > 25.000 QR
|
5 (11.6)
13 (30.2)
25 (58.1)
|
6 (6.5)
33 (35.5)
54 (58.1)
|
11 (8.1)
46 (33.8)
79 (58.1)
|
5 (1.8)
52 (19.1)
215(79.0)
|
0.001*
|
Age at first marriage:
- < 20 years
- 20 - < 25
- 25 - < 30
- 30 - <35
- > 35
Mean + SD
|
6(14.0)
18(41.9)
10(23.3)
4(9.3)
5(11.6)
25.8 + 6.8
|
26(28.0)
37(39.8)
23(24.7)
5(5.4)
2(2.2)
22.7 + 4.6
|
32(23.5)
55(40.4)
33(24.3)
9(6.6)
7(5.1)
23.7 +5.6
|
86(31.6)
113(41.5)
59(21.7)
12(4.4)
2(0.7)
22.1 + 4.4
|
0.024*
|
Husband’s absence:
- Never been absent
- Yes, occasionally
- Yes, frequently/seasonally
- Yes, most of the time
- Yes, "collectively"
|
33 (76.7)
4 (9.3)
4 (9.3)
2 (4.7)
10(23.3)
|
60 (64.5)
17 (18.3)
12 (12.9)
4 (4.3)
33 (35.5)
|
93 (68.4)
21 (15.4)
16 (11.8)
6 (4.4)
43 (31.6)
|
232 (85.3)
19 (7.0)
16 (5.9)
5 (1.8)
40 (14.7)
|
0.001*
|
* p < 0.05
SD: Standard Deviation, QR: Qatari Riyals
Table (2): Distribution of study participants according to their lifestyle-related characteristics, Women Hospital-Hamad Medical Corporation, 2018
Lifestyle history
|
Cases
|
Cases
|
Controls
|
p value
|
Primary Infertility
n = 43 (%)
|
Secondary Infertility
n = 93 (%)
|
Infertility Total
n =136 (%)
|
n = 272 (%)
|
Water pipe smoking:
- No
- Yes, currently
- Yes, previously
- Yes, "collectively"
|
41 (95.3)
1 (2.3)
1 (2.3)
2 (4.7)
|
86 (92.5)
5 (5.4)
2 (2.2)
7 (7.5)
|
127 (93.4)
6 (4.4)
3 (2.2)
9 (6.6)
|
268 (98.5)
3 (1.1)
1 (0.4)
4 (1.5)
|
0.005*
|
Second hand smoking:
- No
- Yes, currently
- Yes, previously
- Yes, "collectively"
|
15 (35.9)
17 (39.5)
11 (25.6)
28 (65.1)
|
42 (45.2)
41 (44.1)
10 (10.8)
51(54.8)
|
57 (42.0)
58 (42.6)
21 (15.4)
79 (58.1)
|
153 (56.3)
103 (37.9)
16 (5.9)
119 (43.8)
|
0.006*
|
Vigorous exercise:
- No
- Yes
|
40 (93.0)
3 (7.0)
|
84 (90.3)
9 (9.7)
|
124 (91.2)
12 (8.8)
|
263 (96.7)
9 (3.3)
|
0.017*
|
Childhood obesity:
- No
- Yes
|
34 (79.1)
9 (20.9)
|
70 (75.3)
23 (24.7)
|
104 (76.5)
32 (23.5)
|
238 (87.5)
34 (12.5)
|
0.004*
|
Steady weight gain since marriage:
- No
- Yes
|
11 (25.6)
32 (74.4)
|
25 (26.9)
68 (73.1)
|
36 (26.5)
100 (73.5)
|
203 (74.6)
69 (25.4)
|
0.001*
|
Recent weight gain:
- No
- Yes
|
15 (34.9)
28 (65.1)
|
38 (40.9)
55 (59.1)
|
53 (39.0)
83 (61.0)
|
232 (85.3)
40 (14.7)
|
0.001*
|
|
|
|
|
|
|
|
* p < 0.05
Table (3): Distribution of study participants according to gynaecological history, Women Hospital-Hamad Medical Corporation, 2018
Gynecological history
|
Cases
|
Cases
|
Controls
|
P value
|
Primary Infertility
n = 43 (%)
|
Secondary Infertility
n = 93 (%)
|
Infertility Total
n =136 (%)
|
n = 272 (%)
|
Menstrual cycle regularity:
- Regular
- Irregular
|
32 (74.4)
11 (25.6)
|
65 (69.9)
28 (30.1)
|
97 (71.3)
39 (28.7)
|
256 (94.1)
16 (5.9)
|
0.001*
|
Menstrual irregularity:
- < 6 month
- ≥ 6 month
|
n = 11
1 (9.1)
10 (90.9)
|
n = 28
4 (14.3)
24 (85.7)
|
n = 39
5 (12.8)
34 (87.2)
|
n = 16
8 (50.0)
8 (50.0)
|
0.001*
|
Duration of menstrual cycle:
- < 21 days
- 21 - 35 days
- > 35 days
|
0 (0.0)
33 (76.7)
10 (23.3)
|
1 (1.1)
61 (65.6)
31 (33.3)
|
1 (0.7)
94 (69.1)
41 (30.2)
|
0 (0.0)
252 (92.6)
20 (7.4)
|
0.001*
|
Menorrhagia:
- No
- Yes
|
31 (72.1)
12 (27.9)
|
72 (77.4)
21 (22.6)
|
103 (75.7)
33 (24.3)
|
260 (95.6)
12 (4.4)
|
0.001*
|
Intermenstrual bleeding:
- No
- Yes
|
38 (88.4)
5 (11.6)
|
84 (90.3)
9 (9.7)
|
122 (89.7)
14 (10.3)
|
272(100.0)
0 (0.0)
|
0.001*
|
Dysmenorrhoea:
- No
- Yes
|
30 (69.8)
13 (30.2)
|
74 (79.6)
19 (20.4)
|
104 (76.5)
32 (23.5)
|
256 (94.1)
16 (5.9)
|
0.001*
|
Secondary amenorrhea:
- No
- Yes
|
31 (72.1)
12 (27.9)
|
67 (72.0)
26 (28.0)
|
98 (72.1)
38 (27.9)
|
258 (94.9)
14 (5.1)
|
0.001*
|
Chronic pelvic pain
- No
- Yes
|
27 (62.8)
16 (37.2)
|
52 (55.9)
41 (44.1)
|
79 (58.1)
57 (41.9)
|
255 (93.8)
17 (6.2)
|
0.001*
|
Abnormal vaginal discharge:
- No
- Yes
|
36 (83.7)
7 (16.3)
|
64 (68.8)
29 (31.2)
|
100 (73.5)
36 (26.5)
|
261 (96.0)
11(4.0)
|
0.001*
|
Painful urination:
- No
- Yes
|
38 (88.4)
5(11.6)
|
80 (86.0)
13(14.0)
|
118 (86.8)
18 (13.2)
|
269 (98.9)
3 (1.1)
|
0.001*
|
Dyspareunia:
- No
- Yes
|
25 (58.1)
18 (41.9)
|
55 (59.1)
38 (40.9)
|
80 (58.8)
56 (41.2)
|
262 (96.3)
10 (3.7)
|
0.001*
|
* p < 0.05
Table (4): Distribution of secondary infertility participants and controls according to their obstetric history, Women Hospital-Hamad Medical Corporation, 2018
Obstetric history
|
Secondary infertility
n = 93 (%)
|
Controls
n = 272 (%)
|
p value
|
Previous conception:
- No
- Yes
|
0 (0.0)
93 (100.0)
|
42 (15.4)
230 (84.6)
|
0.001*
|
Time from previous conception:
- < 5 years
- 5 - <10 years
- 10 - <15 years
- ≥ 15 years
|
n = 93
47 (50.5)
38 (40.9)
4 (4.3)
4 (4.3)
|
n = 230
194 (84.3)
32 (14.0)
4 (1.7)
0 (0.0)
|
0.001*
|
Outcome of previous conception:
- Stillbirth
- Never
- Happened once or more
- Miscarriage
|
80 (86.0)
13 (14.0)
35 (37.6)
35 (37.6)
23 (24.8)
|
n = 230
219 (95.2)
11 (4.8)
124 (53.9)
57 (24.8)
49 (21.3)
|
0.004*
0.021*
|
Post-partum / post-abortal infection:
- No
- Yes
|
83 (89.2)
10 (10.8)
|
n = 230
223 (97.0)
7 (3.0)
|
0.005*
|
Caesarean section:
- No
- Yes
|
55 (59.1)
38 (40.9)
|
192 (70.6)
80 (29.4)
|
0.042*
|
* p < 0.05
Table (5): Distribution of study participants according medical/medication history, Women Hospital-Hamad Medical Corporation, 2018
Medical/ Medication history
|
Cases
|
Cases
|
Controls
|
p value
|
Primary Infertility
n = 43 (%)
|
Secondary Infertility
n = 93 (%)
|
Infertility Total
n =136 (%)
|
n = 272 (%)
|
Hypothyroidism:
- No
- Yes
|
35 (81.4)
8 (18.6)
|
75 (80.6)
18 (19.4)
|
110 (80.9)
26 (19.1)
|
242 (89.0)
30 (11.0)
|
0.025*
|
Hyperprolactinemia:
- No
- Yes
|
34 (79.1)
9 (20.9)
|
78 (83.9)
15 (16.1)
|
112 (82.4)
24 (17.6)
|
255 (93.8)
17 (6.2)
|
0.001*
|
Depression and/or other psychological disorders:
- No
- Yes
|
40 (93.0)
3 (7.0)
|
88 (94.6)
5 (5.4)
|
128 (94.1)
8 (5.9)
|
270 (99.3)
2 (0.7)
|
0.002*
|
Polycystic ovarian syndrome:
- No
- Yes
|
21 (48.8)
22 (51.2)
|
43 (46.2)
50 (53.8)
|
64 (47.1)
72 (52.9)
|
220 (80.9)
52 (19.1)
|
0.001*
|
Fibroid uterus:
- No
- Yes
|
37 (86.0)
6 (14.0)
|
86 (92.5)
7 (7.5)
|
123 (90.4)
13 (19.6)
|
261 (96.0)
11 (4.0)
|
0.026*
|
Appendectomy
- No
- Yes
|
41 (95.3)
2 (4.7)
|
84 (94.3)
9 (9.7)
|
125 (91.9)
11 (8.3)
|
263 (96.7)
9 (3.3)
|
0.035*
|
Prolonged steroid:
- No
- Yes
|
42 (97.7)
1 (2.3)
|
84 (90.3)
9 (9.7)
|
126(92.6)
10 (7.4)
|
267 (98.2)
5 (1.8)
|
0.050*
|
Hormonal therapy:
- No
- Yes
|
15 (34.9)
28 (65.1)
|
19 (20.4)
74 (79.6)
|
34 (25.0)
102(75.0)
|
260 (95.6)
12 (4.4)
|
0.001*
|
Prolonged high dose of NSAID:
- No
- Yes
|
40 (93.0)
3 (7.0)
|
78 (83.9)
15 (16.1)
|
118(86.8)
18 (13.2)
|
261 (96.0)
11 (4.0)
|
0.001*
|
Anti-obesity
(Xenical®, Meridia®):
- No
- Yes
|
42 (97.7)
1 (2.3)
|
81 (87.1)
12 (12.9)
|
123(90.4)
13 (9.6)
|
267 (98.2)
5 (1.8)
|
0.001*
|
|
|
|
|
|
|
|
* p < 0.05
NSAID: Non-Steroidal Anti Inflammatory Drugs
Xenical® is the trade name for Orlistat, Meridia® is the trade name for Sibutranine
Table (6): Distribution of study participants according medical/medication history, Women Hospital-Hamad Medical Corporation, 2018
Birth -control/ sexual history
|
Cases
|
Cases
|
Controls
|
p value
|
Primary Infertility
n = 43 (%)
|
Secondary Infertility
n = 93 (%)
|
Infertility Total
n =136 (%)
|
n = 272 (%)
|
Previous postpone of child bearing:
- No
- Yes
|
38 (88.4)
5 (11.6)
|
45 (48.4)
48 (51.6)
|
83 (61.0)
53 (39.0)
|
88 (32.4)
184 (67.6)
|
0.001*
|
Hormonal control:
- No
- Yes
|
n = 5
2 (40.0)
3 (60.0)
|
n = 48
13 (27.1)
35 (72.9)
|
n = 53
15 (28.3)
38 (71.7)
|
n = 184
92 (50.0)
92 (50.0)
|
0.006*
|
Birth control through natural / barrier methods:
- No
- Yes
|
n = 5
3 (60.0)
2 (40.0)
|
n = 48
39 (81.2)
9 (18.8)
|
n = 53
42 (79.2)
11 (20.8)
|
n = 184
106 (57.6)
78 (42.4)
|
0.004*
|
Awareness about fertility window:
- No
- Yes
|
18 (41.9)
25 (58.1)
|
38 (40.9)
55 (59.1)
|
56 (41.2)
80 (58.8)
|
51 (18.8)
221 (81.2)
|
0.001*
|
Loyalty to fertility window:
- No
- Yes
|
24 (55.8)
19 (44.2)
|
51 (54.8)
42 (45.2)
|
75 (55.1)
61 (44.9)
|
71 (26.1)
201 (73.9)
|
0.001*
|
|
|
|
|
|
|
|
* p < 0.05
Table (7): Distribution of study participants according to their family history, Women Hospital-Hamad Medical Corporation, 2018
Family history
|
Cases
|
Cases
|
Controls
|
p value
|
Primary Infertility
n = 43 (%)
|
Secondary Infertility
n = 93 (%)
|
Infertility Total
n =136 (%)
|
n = 272 (%)
|
Female infertility:
- No
- Yes
|
24 (55.8)
19 (44.2)
|
55 (59.1)
38 (40.9)
|
79 (58.1)
57 (41.9)
|
197 (72.4)
75 (27.6)
|
0.004*
|
Menstrual cycle irregularity:
- No
- Yes
|
28 (65.1)
15 (34.9)
|
63 (67.7)
30 (32.3)
|
91 (66.9)
45 (33.1)
|
227 (83.5)
45 (16.5)
|
0.001*
|
Polycystic ovarian syndrome:
- No
- Yes
|
30 (69.8)
13 (30.2)
|
69 (74.2)
24 (25.8)
|
99 (72.8)
37 (27.2)
|
221 (81.3)
51 (18.8)
|
0.050*
|
Fibroid:
- No
- Yes
|
34 (79.1)
9 (20.9)
|
75 (80.6)
18 (19.4)
|
109 (80.1)
27 (19.9)
|
246 (90.4)
26 (9.6)
|
0.004*
|
Diabetes mellitus:
- No
- Yes
|
16 (37.2)
27 (62.8)
|
35 (37.6)
58 (62.4)
|
51 (37.5)
85 (62.5)
|
197 (72.4)
75 (27.6)
|
0.001*
|
Thyroid disease:
- No
- Yes
|
30 (69.8)
13 (30.2)
|
55 (59.1)
38 (40.9)
|
85 (62.5)
51 (37.5)
|
219 (80.5)
53 (19.5)
|
0.001*
|
|
|
|
|
|
|
|
* p < 0.05
Table (8): Distribution of study participants according to their WHO-BMI classification/ PHQ-2 score, Women Hospital-Hamad Medical Corporation, 2018
WHO-BMI classification
|
Cases
|
Cases
|
Controls
|
p value
|
Primary Infertility
n = 43 (%)
|
Secondary Infertility
n = 93 (%)
|
Infertility Total
n =136 (%)
|
n = 272 (%)
|
Underweight
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
7 (2.6)
|
0.002*
|
Normal weight
|
6 (13.9)
|
15 (16.1)
|
21 (15.4)
|
68 (25.0)
|
Overweight
|
14 (32.6)
|
27 (29.0)
|
41 (30.2)
|
98 (36.0)
|
Obese
|
23 (53.5)
|
51 (54.9)
|
74 (54.4)
|
99 (36.4)
|
Mean BMI + SD
|
30.9 + 6.2
|
31.6 + 6.6
|
31.4 + 6.4
|
28.7 + 6.1
|
0.001*
|
PHQ-2 score result:
- Negative
- Positive
|
38 (88.4)
5 (11.6)
|
79 (84.9)
14 (15.1)
|
117 (86.0)
19 (14.0)
|
257 (94.5)
15 (5.5)
|
0.004*
|
* p < 0.05
Table (9): Infertility risk factors: Results of the multivariate logistic regression analysis, Women Hospital-Hamad Medical Corporation, 2018
Independent risk factors
|
Adjusted odds ratio (aOR)
|
p-value
|
95% Confidence interval (CI)
|
Model I: Independent risk factors of infertility
|
Age of participants (> 35 years)
|
3.72
|
0.008*
|
1.41 - 9.83
|
Second hand smoking
|
2.44
|
0.008*
|
1.26 - 4.73
|
Steady weight gain since marriage
|
4.65
|
0.001*
|
2.43 - 8.91
|
Recent weight gain
|
4.87
|
0.001*
|
2.54 - 9.32
|
Menstrual cycle irregularity
|
4.20
|
0.031*
|
1.14 - 15.49
|
Sexually transmitted infections (STIs) suggestive symptoms:
- Lower abdominal / pelvic dull pain
- Abnormal vaginal discharge
- Dyspareunia
|
3.46
3.32
7.04
|
0.002*
0.019*
0.001*
|
1.57 - 7.63
1.22 - 9.03
2.76 - 17.95
|
Fallopian tube blockage
|
5.45
|
0.003*
|
1.75 - 16.95
|
Model II: Independent risk factors of secondary infertility**
|
Time from last conception ≥5 years
|
5.8
|
0.001*
|
3.28 - 10.21
|
History of stillbirth (once or more)
|
2.63
|
0.042*
|
1.04 - 6.67
|
Miscarriage (once or more)
|
2.11
|
0.008*
|
1.21 - 3.68
|
Post-partum / Post-abortal infection
|
3.75
|
0.016*
|
1.27 - 11.06
|
* p < 0.05
** Model II included comparison between secondary infertile women (n = 93) and controls who reported previous conception (n = 230)