Addressing the Rehabilitation Needs of Women Experiencing Infertility in Ethiopia: Time for Action

The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability or potential target of rehabilitation interventions. This study aimed to determine what rehabilitation-related services and supports are available for women experiencing infertility in Ethiopia. We used an Interpretive Description design. We purposefully selected fourteen rehabilitation, medical, and policy service providers from diverse institutions across three geographical locations. We used semi-structured questions during our in-person and telephone interviews. The data were analyzed using reflexive thematic analysis with the assistance of NVivo. We identified five main themes, including (a) policies related to infertility, (b) the concept that disabilities are physically visible fails to recognize infertility, (c) the need for rehabilitation services for women with infertility, (d) the importance of wellness services for women experiencing infertility, and (e) the role of religion in rehabilitation services. In conclusion, it is essential to strengthen the policies around infertility, incorporate rehabilitation services in fertility care, and view infertility as a disabling condition for women who experience it in Ethiopia.

[Randomized trial of a lifestyle program in obese infertile women]

OBJECTIVE

Small intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcome, but large randomized controlled trials (RCT) are lacking. Our objective was to investigate the effects of a lifestyle intervention in obese infertile women in a multicenter RCT.

DESIGN

We randomly assigned infertile women with body mass index ≥ 29 k/m² to a six-month lifestyle intervention preceding infertility treatment or to prompt infertility treatment. The primary outcome was the vaginal birth of a healthy singleton at term within 2 years of randomization.

RESULTS

Between June 2009-June 2102 we randomly allocated 577 women to one of two treatment strategies: 290 to lifestyle intervention preceding infertility treatment (intervention group) and 287 to prompt infertility treatment (control group). Three women withdrew informed consent, leaving 289 and 285 women for analysis. Discontinuation rate during the lifestyle intervention was 22%. Mean weight loss in the intervention group was 4.4 kg and in the control group 1.1 kg ( p < 0.001); the primary outcome occurred in 76 women (27%) in the intervention group versus 100 (35%) in the control group (RR: 0.77, 95% CI 0.60 to 0.99). The number of natural conceptions leading to ongoing pregnancies was 73 (26%) versus 46 (16%) (RR: 1.6, 95% CI 1.2 to 2.2). Maternal pregnancy-related and labor-related complications and neonatal complications were comparable.

CONCLUSION

In obese infertile women lifestyle intervention preceding infertility treatment did not result in better rates of vaginal birth of healthy singletons at term as compared to prompt infertility treatment.

[The use of restorative medicine technologies for the rehabilitation of the patients presenting with endometriosis of external genitalia]

This paper reports the results of analysis of the psycho-emotional status and pain syndrome in the women presenting with endometriosis of external genitalia treated with a combination of hormonal preparations and balneotherapy. A total of 216 infertile patients were involved in the study. The duration of the infertility period varied from 1.5 to 19 years. All the patients underwent surgical intervention. The influence of rehabilitative therapy on the quantitative vital indices (psycho-emotional adaptation to the social environment and pain intensity) was estimated before and after the treatment. The patients were divided into 3 groups. Those of group 1 received an oral contraceptive (30 mcg of ethinylestradiol plus 2 mg dienogest) as a continuous three-cycle course (63 tablets) followed by its discontinuation for the 7 day menstrual period and the final three-cycle course (total duration of therapy 6 months). The patients of group 2 were treated with injections of agonists of gonadotropin releasing hormone (GnRH) at a dose of 3.75 mg once every 4 weeks (total duration 6 months). In group 3, the injections of GnRH agonists (3.75 mg once every 4 weeks, total duration 6 months) were combined with a course of balneotherapy using radon. All the three rehabilitative modalities produced a well-apparent positive effect. Chronic pelvic pain before treatment was reported by 90,3% of the patients. After the treatment, the number of such women in groups 1, 2, and 3 decreased to 20,8%, 12,5%, and 30,6% respectively Dyspareunia in the pre-treatment period was diagnosed in 66,7% of the patients. After treatment, this pathology persisted only in 23,6%, 18,1%, and 31,9% of the patients in groups 1, 2, and 3 respectively. Psycho-emotional disorders before treatment were documented in 90,3% of the patients compared with 27,8%, 25%, and 30,6% after therapy. It is concluded that all the three therapeutic modalities markedly improved health conditions of the patients presenting with endometriosis of external genitalia, but the combination of GnRH agonists with radon therapy produced the most pronounced clinical effect.

[Rehabilitation of the patients with polycystic ovary syndrome during sanatorium-and-spa treatment]

An original method for the combined non-medicamentous balneotherapeutic treatment of the patients with polycystic ovary syndrome and compromised reproductive function has been developed. The method designed to be applied after laparoscopic intervention for the management of infertility includes the use of radon water in combination with acupuncture. It was shown to help to restore regular menstrual cycles in half of the treated women and normalize fertility in some of them.

[Electromagnetic radiation of extra high frequency as a method of rehabilitation after surgical treatment of tubal-peritoneal infertility]

Seventy four patients entered the placebo-controlled study of rehabilitation EHF therapy 1 month after surgical laparoscopy for tubal-peritoneal infertility. It was found that early EHF therapy corrects hemodynamics in small pelvis vasculature characteristic for chronic inflammation of the uterine appendages thus raising the rate of impregnation.

[Recovered reproductive function in female patient with sever genital tuberculosis]

In severe genitoperitonial tuberculosis, conglomerate forms of the disease, and liquid accumulation between intestinal loop adhesions, laparotomy may verify the diagnosis in the shortest time while other diagnostic methods cannot be used due to contraindications for them. The operation should be maximally saving and only diagnostic. Timely combined antituberculous treatment concurrently with surgical interventions yields good results of recovered reproductive function.

[Physical factors in the rehabilitative treatment of patients who have undergone operations on the fallopian tubes]

Treatment results assessed in 170 females of the reproductive age who had previously undergone reconstructive-plastic operations on uterine tubes provide evidence for effectiveness of differentiated use of impulse infrared laser and sinusoidal modulated currents in combination with balneotherapy. The above physiotherapeutic modalities are considered good aftertreatment for females operated on the uterine tubes.

[A program of intensive nondrug treatment for functional tubal infertility]

The program of combined use of nonpharmaceutical modalities to treat functional tubal infertility proposed by the authors is effective in correction of contractile activity of the uterine tubes and psychoemotional condition of the patients. Due to the treatment, the reproductive function recovered in 56% of the patients under 30 years of age who had been infertile less than 5 years.

[Effect of health resort treatment on the status of the oxidant and antioxidant systems in women with disordered reproductive function residing in the area of the Chernobyl Atomic Power Plant accident]

Lipid peroxidation system and its reaction to balneotherapy (hydrogen sulfide and iodine bromide exposure) were examined in 60 women with reproductive system disorders living in radionuclide pollution zone after the Chernobyl accident. Certain specificities of lipid peroxidation system in this patient population were detected and a favorable effect of the said balneotherapy noted.

[Functional evaluation of the effectiveness of experimental reconstructive and plastic operations on the uterine horns]

In the given experimental model, tubo-plastic surgery was done with the use of locally produced fibrin glue (Fk-1), and commercial product "Beriplast" (FRG). In the control group microsurgical technique was adopted in the uterine horn of rats. It was proved that Fibrin glue reduces the frequency of post operative adhesion formation in the area of anastomosis and the chance of pregnancy is increased in comparison to microsurgical techniques.

[Extracorporeal fertilization and embryo transfer: a medico-ethical topic?]

In vitro fertilization and subsequent embryo transfer remains one of the most burning topical issues of medicine and medical ethics today. Like every individual ethical problem, extracorporeal fertilization initiated the question of the ethical and metaethical (anthropological) context of the origin of the problem and from which an answer may be forthcoming. The fact has to be taken into account that a uniform ethical culture is no longer possible on the grounds of the pluralism of creeds and world opinions. Ethically acceptable compromises have again and again to be looked for. However, the search for an ethical consensus of views runs the risk of being unable to keep pace with the dynamics of medical and technical progress.