Dados do Trabalho

Title

Epidemiology of Infertility Among Patients Referred to a Public Secondary Medical Care Center

Objective

This study aims to present epidemiological data from a public secondary medical care center specialized in infertility.

Methods

A cross-sectional study was conducted, analyzing data from 1217 patients referred to this public secondary care center for infertility between March 2022 and July 2023. These patients were firstly referred from public primary care centers and, if necessary, would be referred to a public tertiary center for assisted reproduction treatments (ART). Data were manually collected from electronic medical records and results are presented as percentages.

Results

The study included 1217 female patients. The majority of patients (61%; n=741) was over 35 years old, with almost half of these women over 40 years old (n=369; 30%), including 171 patients over 43 years old. Additionally, 16% of patients were younger than 30 years old, and 23% fell within the age range of 30-35 years.
Primary infertility accounted for 60% of cases. Among couples, 15% (n=180) had been trying to conceive for more than 10 years, while 21% (n=252) experienced infertility for less than 3 years. The cause of infertility could not be determined for approximately 20% of patients (n=207) due to ongoing workup or loss to follow-up.
Among the 1010 patients with a stablished cause of infertility, the most common causes identified during the initial work up were tubal factor (21%; n=211), male factor (20%; n=197), ovulatory function abnormalities (17%; n=170), endometriosis (13%; n 132), and unexplained infertility (11%; n=108). Combined factors were present in 3% of couples, and a small proportion of patients (less than 3%; n=31) were in a same-sex relationship or seeking independent reproduction. Uterine factor and advanced maternal age were also identified as causes of infertility, while 5% of couples were referred due to recurrent pregnancy loss.

Conclusion

The predominance of patients over 35 years old among those referred to a secondary center aligns with existing literature, which highlights a higher occurrence of infertility between the ages of 35 and 44 in women.
The prevalence of tubal factor, ovulatory function abnormalities, and unexplained infertility in this study is consistent with findings in the literature. However, male factor and combined causes were less frequent in this study compared to general reports.
World Health Organization emphasizes the importance of identifying, preventing, and treating infertility to promote individual’s overall health. Given that over 70% of the Brazilian population relies on the public health system (SUS) and very few ART centers are available through SUS and the medications used for treatment are not provided by the system at all, studying epidemiological data from these scarce centers specialized in human fertility is crucial for future improvements in public health policies aimed at expanding population’s access to ART.

Keywords

Infertility epidemiology, Public Health.