Female Infertility and Obesity across the United States—A Geographic Cross-Sectional Analysis

This cross-sectional study investigates a connection between female infertility and obesity across various regions of the United States, utilizing data from the NIH’s “All of Us” Researcher Workbench. Analysis suggested that the Southern region exhibited the highest percentage of concurrently infertile and obese females at 32.3%, in contrast to the lowest in the Western region at 28.7%. The findings underscore the significant regional disparities in obesity-related infertility, particularly in medically underserved areas where healthcare access is limited. The study highlights the urgent need for targeted public health interventions, particularly in the Southern United States, to address the rising prevalence of obesity and its impact on infertility. Further, these results advocate for enhanced public health education and policies aimed at improving healthcare accessibility, with the goal of mitigating the adverse effects of obesity on reproductive health.

Ultrasound Causes of Female Infertility at the Fertilia Medical Clinic in Bamako

Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultrasound. The objective of our study was to investigate the ultrasound causes likely to prevent the occurrence of pregnancy in a group of infertile and subfertile women. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between January 2017 and January 2022, which involved 250 women wishing to become pregnant (infertile or subfertile), who came for pelvic ultrasound or follicular monitoring and who agreed to participate in our study. The parameters used were ultrasound reports including uterine, ovarian and tubal pathologies. It should be noted that in some cases no ultrasound cause of infertility was found. Data were entered and analyzed in SPSS. Results: 250 women were recruited into our. The average age was 32 years with extremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 years old. 139 patients or 55.6% had secondary infertility against 44.4% primary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 patients or 19.2% had no significant ultrasound abnormality. The most represented ultrasound lesions were of uterine origin with 72.20%, 23.7% ovarian lesions and 04% tubal lesions. Uterine lesions were dominated by myomas, adenomyosis, endometrial polyps, uterine malformations and synechiae. As for ovarian lesions we noted cysts, polycystic ovary syndrome (PCOS), ovarian endometriosis, non-follicular ovaries and tubal ultrasound lesions showed unilateral or bilateral hydrosalpinx. Conclusion: In our study, ultrasound was an invaluable contribution to the diagnosis of the causes likely to explain subfertility and infertility in our respondents. She highlighted uterine, ovarian and tubal lesions, some of which could be corrected and pregnancies ensued.

Place of Selective Tubal Catheterization in the Management of Female Infertility in Togo

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction. Method: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative β-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after the failure of spontaneous tubal opacification. The parameters studied related to socio-epidemiological, clinical and radiological data. Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified;62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%. Conclusion: Selective tubal catheterization is a simple technique, without major complications with an efficiency close to natural fertility. It should be proposed as the first intention before any other procedure in the treatment of infertility by proximal tubal obstruction.

Characterization and risk factors for unexplained female infertility in Sudan:A case-control study

BACKGROUND Female infertility with unknown causes(unexplained)remains one of the mysteries in the reproductive health field,where the diagnostic evidence is still weak and the proposed treatments still work with unknown methods.However,several studies have proposed some possible causes and risk factors for unexplained female infertility.AIM To characterize and identify factors associated with unexplained infertility in Sudanese women.METHODS A matched(age and body mass index)case-control study was conducted from March 2021 to February 2022.The study samples were 210 women with unexplained infertility(UI)and 190 fertile women of reproductive age who were attending the maternity hospitals and fertility clinics in Khartoum,Sudan.The risk factors of unexplained infertility were identified using a structured,pretested questionnaire containing information on socio-demographic variables,anthropometrics,clinical diagnosis of infertility,behavioral factors,physical activity assessment,diversity,and consumption of different food groups by the study participants.RESULTS The results showed a higher proportion of women diagnosed with UI were residents of rural areas than controls(21.4%vs 11.1%,P<0.05),and previous miscarriages and/or abortions were more common in fertile women compared with infertile women(13.16%vs 5.71%,P<0.05).Additionally,infertile women had a significantly(P<0.05)higher proportion of family history of infertility(explained and unexplained)compared with controls.Finally,after controlling for the effects of potentially confounding variables using multivariable logistic regression analysis,only marital status,family history of infertility,use of modern contraceptives,smoking,caffeine consumption,physical activity level,meals consumed,other vitamin-A-rich fruits and vegetables,and other vegetables were found to be significant(P<0.05)factors associated with unexplained infertility among Sudanese women.CONCLUSION Married women with a family history of infertility who smoke and consume a high amount of caffeine,who live a sedentary lifestyle,and who consume more than two meals free of vitamin-Arich fruits and/or vegetables and/or other vegetables per day are at the highest risk of developing unexplained infertility.

Traditional Chinese Medicine Compound Mianbu Mixfang Is Effective in Treating Immunological Infertility: a Female Mice

Objective To study the therapeutic effectivess of Traditional Chinese Medicine compound mixture Mianbu Fang (Immunological infertility therapy) on immunological infertility caused by antisperm antibody (AsAb) in female mice. Materials & Methods Forty-two female Kunming mice were evenly divided into 7 groups by weight. Group A was control group; Group B was model of infertility. Group C, D and E were fed with normal, half and double dosage of Mianbu I respectively. Group F and G were fed with Mianbu II and prednisone Acetates respectively. Animal model of immunological infertility were set up by injecting mice sperm to the other 36 Kunming female mice except Group A. The AsAb levels in serum, cervical mucus were measured, the histological and immunohistochemistry changes in ovary and endometrium were observed, and the pregnancy indexes were compared in different groups. Results Compared with the infertility model group, the AsAb level in serum and cervical mucus in treatment group was lower. Less immune compounds in ovary and endometrium and atretic follicle of ovary was found in treatment group than in model and control group. The immune compounds in ovary and endometrium were less in the treatment group than that in the model and control group. Conclusion By regulating immunological system, Traditional Chinese Medicine compound mixfang Mianbu Fang lowers AsAb in the circulation system and special organs, eliminates immunological compound, repairs tissue impairment and increases pregnancy of female mice.

Interference with the C-terminal structure of MARF1 causes defective oocyte meiotic division and female infertility in mice

Meiosis-arrest female 1（MARF1） is a recently identified key oogenic regulator essential for the maintenance of female fertility and genome integrity in mice. However, the detailed functions and the underlying mechanisms of MARF1 remain elusive. Here, in an attempt to create a mouse model expressing fluorescent protein-tagged MARF1 to facilitate further exploration of the roles of MARF1 in oocytes, we produced a Marf1-eGFP knockin（KI） mouse line in which the C-terminal structure and function of MARF1 were interfered by its fusing eGFP peptide. Using these Marfl-eGFP-KI mice, we revealed, unexpectedly, the functions of MARF1 in the control of oocyte meiotic division.We found that the Marfl-eGFP-KI females ovulated mature oocytes with severe meiotic and developmental defects,and thus were infertile. Moreover, meiotic reinitiation was delayed while meiotic completion was accelerated in the KI-oocytes, which was coincident with the increased incidence of oocyte aneuploidy. Therefore, MARF1 is indispensable for maintaining the fidelity of homolog segregation during oocyte maturation, and this function relies on its C-terminal domains.

An evaluation of methods for the test of tubal patency in female infertility

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A Retrospective Study of the Prevalence of Female Infertility in the Southwest Region, Cameroon

Background: Infertility is a major reproductive health care problem that affects the wellbeing of women. Although views vary between cultures, infertility is seen almost exclusively as a woman’s problem in Africa with secondary infertility being the most prevalent while sexually transmitted infections the most investigated cause of infertility. Objective: The aim of this study was to determine the prevalence of female infertility in the Limbe and Buea Regional hospitals of the Southwest region of Cameroon from 2015-2019. Materials and Methods: A retrospective descriptive design was used which involved studying clinical files of women within the reproductive age group (15 - 49) with infertility problems, at the gynaecological and maternity units of the selected hospitals in the Southwest region of Cameroon over a period of five years (2015-2019). Data were collected from all files included in the study. Results: A total of 4609 females visited the two hospitals for investigation and 1111 files were identified with infertility giving prevalence of 24 %. Three hundred and forty-three (343;31%) presented with primary infertility while seven hundred and sixty-eight (768;69%) had secondary infertility. The average age of affected female was 31.5 making age the predisposing factor of infertility because after the peak of 25 years, infertility started decreasing. Employment with salary and the association between diagnosis and age had a p-value < 0.005 which was considered significant in this study. Conclusion: This study found that the prevalence of infertility in Southwest Cameroon is high with secondary infertility being most predominant among infertile women with a prevalence of 69% caused principally by sexually transmitted infection (STIs). Age and occupation were significantly associated with infertility. Routine laboratory screening of women of reproductive age may reduce the high prevalence of infertility in the study area.

Contribution of Laparoscopy in the Management of Female Infertility in Low Resource Countries: A Review of 208 Cases at the YaoundéGeneral Hospital, Cameroon

Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.

Female infertility and laparoscopic surgery: A series of 415 operations at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon

Objective: To describe the practice of laparoscopic surgery in the treatment of infertility at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital. Materials and Methods: This was an observational study with retrolective data collection. All patients who underwent laparoscopy for infertility with a complete file were recruited. Data were collected on a pre-established form and analyzed with Microsoft Excel 2007 software. Results: Six hundred and thirty-three women, representing 6.9% of gynecologic operations, underwent laparoscopic surgery during the study period. Infertility accounted for 69.8% (442 cases) of the indications. Four hundred and fifteen files were analyzed. The commonest intraoperative findings were: tubo-peritoneal adhesions (71.6%), hydrosalpinx with distal tubal occlusion (41.5%), peri-hepatic adhesions (22.4%), uterine fibroids (20.2%) and tubal phimosis (14.0%). Adhesiolysis, neosalpingostomy and fimbrioplasty were the commonest surgical gestures. At the end of the procedure, the best tube was staged as favorable in 57.6% of our patients. A complication rate of 4.3% was observed. Conclusion: Infertility is the main indication for laparoscopic surgery in our setting. The main operative findings are tubo-peritoneal adhesions and hydrosalpinx. The most practiced tubal surgical gesture is neosalpingostomy. Half of the recruited women have a favorable stage for the best tube. The complication rate is low.

Role of Laparoscopic Surgery in the Management of Female Infertility at the Department of Gynecology of Hôpital du Mali

Infertility is a socio-cultural drama in Africa, especially in Mali and remains difficult for couples to overcome. Laparoscopy, also called minimally invasive surgery or keyhole surgery, is an operative technique that permits to explore the pelvis and perform an appropriate therapeutic procedure. The objective of our work was to assess the role of laparoscopic surgery in the treatment of female infertility at Hopital du Mali. It was a retrospective descriptive study that was conducted over a period of 5 years (January 2013 to December 2018). Any patients followed for infertility and who underwent laparoscopic surgery in the gynecology department over a period of two (2) years were included. The outcome of laparoscopic surgery was evaluated in terms of conception of pregnancy. We had collected 103 infertile patients out of 2984, with a frequency of 3.45%. The mean age of our patients was 30.2 years. Housewives and out-of-school women accounted for 68.93% and 54.37% respectively. Nulligravida represented 41.75%. Regarding infertility, it was primary in 41.75% and secondary in 58.25%, with an average duration of 6.2 years. Systematic chlamydial serology was positive in 62.14% of our patients. Hysterosalpingography (HSG) revealed bilateral tubal obstruction in 53.33% of cases. Laparoscopy found tubal adhesions in 97.80% of cases. Adhesiolysis was the main procedure performed with 84.47% bilateral tubal patency achieved in the methylene blue test. Among our patients who had contracted a pregnancy (22.99%), 85% had carried their pregnancies to term. Tubal damage was the main cause of infertility. Adhesiolysis remains the main laparoscopic procedure for treatment.

Impact of Fibromyalgia on Female Infertility

Fibromyalgia is a chronic, widespread musculoskeletal pain and polyalgic syndrome, evolving for more than three months. Research on its consequences on fertility is therefore relevant to explore. The aim of this study is to highlight the relationship between fibromyalgia and some women’s diseases that induced infertility. The results showed that fibromyalgia is more common in 92.9% of patients wishing to procreate and 64.8% of patients with gynecological disorders. 70.7% of patients with menstrual disorder have fibromyalgia and 76.5% of fibromyalgia patients have myomas. Among ovarian pathologies, 76.5% of women with ovarian dystrophy have fibromyalgia. Fibromyalgia is also very prevalent in women with miscarriage (55.9%) and stillbirth history (90.1%). For all studied situations, a highly significant difference was observed (p < 0.000). All these data suggest that fibromyalgia is related to different situations that can induce infertility in women.

Polycystic Ovarian Syndrome and Female Infertility

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, associated with chronic anovulation and hyperandrogenism. The cause of PCOS is multi-factorial and the mechanism is still unclear. A number of complications are closely related with PCOS such as infertility, hairy and obesity. Approximately up to one-third of females with PCOs have issues with infertility. Obesity is an independent factor which exacerbates infertility in PCOS, reduces the efficacy of infertility treatment and provokes a greater risk of miscarriage. Preconception counseling and guidelines play an initial major role in infertility treatment. The option of the most appropriate treatment depends upon various factors such as age, tubal patency, quality of sperm, experience, and duration of previous treatments and the level of anxiety of the couple. Tubal patency test and semen analysis are mandatory to decide the suitable treatment. Treatment modalities have two measures—non-pharmacological and the pharmacological. Oral clomiphene citrate remains the first line treatment to trigger ovulation. Gonadotrophin and laparoscopic ovarian drilling (LOD) surgery are the other treatment option. In vitro fertilization (IVF) and embryo transfer are the third line treatment and IVF remains the first option in the patient with diagnosed and established bilateral tubal occlusion and/or concentration of recovered motile sperm less than or equal to 5 million. Here, etiology, pathophysiology and molecular mechanisms of PCOS are reviewed, and perspectives are given for further research. The recent development, treatment, and diagnosis of PCOS are also highlighted. The summary will be of guiding significance in the prevention and treatment of PCOS.

Mycosynthesis,characterization and antibacterial properties of AgNPs against multidrug resistant(MDR)bacterial pathogens of female infertility cases

Recently,biosynthesis of silver nanoparticles using bacteria,fungus and plants has emerged as a simple and viable alternative to more complex physical and chemical synthetic procedures.The present investigation explains rapid and extracellular synthesis of silver nanoparticles using fungus Fusarium oxysporum NGD and characterization of the synthesized silver nanoparticles using UV-Vis spectroscopy,scanning electron microscopy,energy dispersive spectroscopy and X-ray diffraction analysis.The size range of the synthesized silver nanoparticles was around 16.3e70 nm.The FTIR studies showed major peaks of proteins involved in the synthesis of silver nanoparticles.Further,antibacterial effect of the silver nanoparticles against multidrug resistant pathogens Enterobacter sp.ANT 02[HM803168],Pseudomonas aeruginosa ANT 04[HM803170],Klebsiella pneumoniae ANT 03[HM803169]and Escherichia coli ANT 01[HM803167]was tested using turbidometric assay at 10,20,30,40 mg AgNPs/ml alone and in combination with ampicillin using agar well diffusion assay.All the resistant bacteria were found to be susceptible to the antibiotic in the presence of the silver nanoparticles.

Methylene Tetra-Hydrofolate Reductase Gene Polymorphism and Endometrial Perfusion in Unexplained Female Infertility

Aim of the study: Examing the role of Methylene tetra-hydrofolate reductase (MTHFR C677T) polymorphisms in unexplained female infertility. Methods: The study was conducted on women with unexplained infertility attending the Infertility Clinic at El-Shatby University Hospital, Alexandria, during the period from October 2020 to October 2021. Uterine artery Doppler assessment and detection of MTHFR C677T gene mutation were done. The frequencies of homozygous and heterozygous gene mutations were determined. Results: In group I, 35 cases had abnormal uterine artery Doppler compared to 22 normal cases in group II. As regards MTHFR C677T gene mutation, 19 cases were positive in group I (7 were homozygous and 12 were heterozygous) and only one case was positive in group II (heterozygous) which was statistically significant. Conclusion: MTHFR C677T gene polymorphisms may play a role in unexplained infertility.

Hysterosalpingography Profile of Utero-Tubal Lesions in Female Infertility in Mopti (Mali, West Africa)

Introduction: Infertility is the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse by a couple of childbearing age. It is a real public health problem because of its high prevalence in both developed and developing countries. Female infertility occupies a prominent place in reproductive health in Africa such as in our country Mali. The objective of this work was to determine the hysterosalpingography profile of utero-tubal lesions in the etiological research of female infertility in Mopti. Materials and Method: This was a cross-sectional descriptive study covering a period of one year from January 2019 to December 2019 in the radiology department of Sominé Dolo Hospital in Mopti. The variables analyzed were patient age and hysterosalpingography results. The hysterosalpingography examination was performed 3 or 4 days after menstruation on a remote-controlled table under fluoroscopic control. Data analysis was done with the aid of SPSS version 22 and Excel 2016 software. Results: During the study period, 9012 patients were seen in the imaging department, including 115 patients, or 1.3% for infertility assessment. The 25 - 29 age group was the most represented with 34 patients or 29.6%. The mean was 30.39 ± 6.96 years with extremes of 17 and 46 years. Tubal abnormalities represented 45 cases or 39.1%. Hydrosalpinx was the most prevalent with 26 cases or 36.6%. Conclusion: Tubal lesions were the most observed, especially hydrosalpinx following. Hysterosalpingography remains the first choice in the radiological assessment of female infertility in our context.

Generation of mitochondrial replacement monkeys by female pronucleus transfer

Mutations in mitochondrial DNA(mtDNA)are maternally inherited and have the potential to cause severe disorders.Mitochondrial replacement therapies,including spindle,polar body,and pronuclear transfers,are promising strategies for preventing the hereditary transmission of mtDNA diseases.While pronuclear transfer has been used to generate mitochondrial replacement mouse models and human embryos,its application in non-human primates has not been previously reported.In this study,we successfully generated four healthy cynomolgus monkeys(Macaca fascicularis)via female pronuclear transfer.These individuals all survived for more than two years and exhibited minimal mtDNA carryover(3.8%–6.7%),as well as relatively stable mtDNA heteroplasmy dynamics during development.The successful establishment of this nonhuman primate model highlights the considerable potential of pronuclear transfer in reducing the risk of inherited mtDNA diseases and provides a valuable preclinical research model for advancing mitochondrial replacement therapies in humans.

Bone marrow edema in a postpartum female following ankle sprain: a case report

Bone marrow edema(BME)is characterized by an accumulation of interstitial fluid within the bone marrow,the cancellous,hematopoietic compartment within bones.[1]BME is divided into two principal categories:idiopathic or primary BME,with an unknown etiology,and secondary BME,which occurs as a result of an identifiable underlying pathology.[2]Although the prevalence of BME is not limited to specific demographic parameters,it shows a predilection for males or individuals assigned male at birth,predominantly aged between the ages of 30 and 60 years,especially in cases of bone marrow edema syndrome(BMES),a rare idiopathic variant.[3]The etiological spectrum of BME is diverse,including oncological entities(such as acute myeloid leukemia and osteosarcoma),degenerative diseases(such as osteoarthritis),infectious processes(osteomyelitis),ischemic conditions(avascular necrosis),metabolic dysfunctions(osteoporosis),inflammatory disorders(rheumatoid arthritis),and traumatic injuries(such as stress fractures).[1,2]Clinically,BME primarily manifests as localized pain,often accompanied by joint effusion and warmth near the affected joint.Diagnostic protocols typically include physical examination,serological assays,bone marrow biopsies,dual-energy X-ray absorptiometry(DEXA)scans,magnetic resonance imaging(MRI),and ultrasonography,with computed tomography(CT)scans and radiographs being less effective.

Understanding female urinary continence-lessons from complications of female urethral surgery

Dear Editor,We share our experience of two significant complications associated with female urethroplasty and their management in understanding the factors contributing to urinary continence.We have also tried to assess the different components of female urinary continence mechanism and the ways to combat the postoperative urinary continence while performing female urethral surgeries(Fig.1).Informed consent was taken from each of the patients before their evaluation and management.They were explained properly and informed consents were taken from them before the publication of this article.

Causes of Infertility of Couples Residing in Libreville

Introduction: According to the World Health Organization, globally one in six people experience infertility in their lifetime. Infertility is considered as a major and global public health issue. In most cases, women bear the burden of infertility to protect the male ego. Although men and women are equally likely to have fertility problems. The aim of this study was to identify the causes of infertility of couples residing in Libreville. Patients and Methods: This was a retrospective descriptive study performed over 2 years, from 1st January 2021 to 31st December 2022. Data was obtained from 162 couples attending the assisted reproduction department of the mother and child hospitals in Libreville. Statistical analysis was done using IBM SPSS Statistics version 22.0 software. Results: During the study period, 28.5% of couples could afford IVF treatment. The average for woman age was 39.1 ± 4.06 while the average age for male patients was 41.53 ± 7.08 years with minimum and maximum age of 34 et 66 years. More than half (58.6%) of female partners were employed in the public sector. Half of the male partners (50%) were employed in the private sector. The median duration of infertility was 6 years. Approximately 49.4% of couples were diagnosed with primary infertility. The most common causes of infertility in female patients were Fallopian tubes obstruction (53.2%), uterine factors (24.2%) and hormonal problems (19.6%). With regards to male factors infertility, testicular causes were predominant (53.6%). Oligoasthenoteratozoospermia were the major semen abnormalities (55.7%) found after semen evaluation. Both male and female partners were sub-fertile in 47.5% of cases. Unexplained infertility was found in 11% of couples. Conclusion: This study showed that the diagnostic of infertility faced by couples residing in Libreville should involve both male and female partner.