Infertility in Ghana: review and studies of the morphology of the Endometrium

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The normal cyclic changes in the endometrium are closely correlated with those in the ovary and fertility is dependent, at least partly, on the ordered sequence of structural changes in the endometrium which occur during the cycle. Infertility is generally defined as the inability of couples of reproductive age to achieve pregnancy despite active attempts to do so for more than a year previous studies have shown that the incidence of infertility is higher in developing countries than in developed ones. However, there is very little published information on the incidence of infertility in Ghana. The aims of this study, therefore, were to review the background of the infertile patients and to examine the endometriuin by serial ultrasonographic measurement of endometrial thickness and histological study of endometrial biopsy. The average thickness of the endometrium was greater in the secretory phase (infertile patients, 6.50 +/- 1.32mm; fertile patients 7.88 +/-1.55mm) than in the early proliferative phase (infertile patients, 2.16 +/- 0.57mm; fertile patients, 2.50 +/- 1.00mm). The texture of the endometrium varied throughout the stages of the cycle studied. The endometrium was more echogenic in the secretory phase arecho-poor in the proliferative phase. Ninety-three per cent of the endometrial biopsies showed secretory activity and about 7% showed proliferative activity. Further analysis of endometrial specimens in the infertile patients by the traditional histological criteria revealed that 81.35% showed normal endometrial development whereas in a 11.86% endometrial development was retarded. These observations suggest that in the group of infertile women studied, anovulation was not the cause of infertility in large majority of the cases. In about 10% of the Study population1 the development of the endometrium appeared retarded Ultrasonography offered an effective noninvasive method for evaluating the thickness of the endometrium.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirement for the award of the Degree of Master of Science in Reproductive Biology, 1996