This was a descriptive cross-sectional study with retrospective data collection conducted in the Department of Gynecology and Obstetrics of the Ebolowa Regional Hospital Center, a referral facility in the South Region of Cameroon. The study period extended from September 22, 2022, to September 22, 2023.

The study population included all couples consulting for infertility at ERH during the study period.

Included were medical records of couples consulting for conception desire in whom a diagnosis of couple infertility was established according to WHO criteria and whose records were complete for key study variables.

Excluded were couples consulting outside the study period, those without usable medical records, and incomplete files lacking essential variables (age, infertility type, main etiology).

A non-probability convenience sampling method was used. All eligible records during the study period were included.

Data were collected using a pretested standardized form and analyzed using Microsoft Excel 2010. Couple’s clinical and paraclinical data were collected from patient file where the diagnosis of tubal obstruction was done by a hysterosalpingography and the diagnosis of Chlamydia trachomatis was done by serology. All other diagnosed male or female abnormalities respected standard procedures.

Descriptive statistics were used, including means, standard deviations, and proportions. Results are presented in tables and figures.

Confidentiality and anonymity were strictly maintained. Authorization was obtained from the Head of the Department of Gynecology and Obstetrics prior to data collection.

During the study period, a total of 1850 gynecological consultations were recorded at the Ebolowa Regional Hospital. Among these, 262 consultations involved couples evaluated for infertility, corresponding to a prevalence of 14.16% among gynecological consultations.

Male partner participation in the diagnostic process was observed in 144 cases (55%), while 45% of male partners did not attend the proposed investigations.

Among women, age ranged from 16 to 45 years, with a mean age of 28.6 ± 4 years. The most represented age group was 26 - 30 years, accounting for 32.1% (84/262) of cases. Among men, ages ranged from 26 to 60 years, with a mean age of 34.5 ± 7 years. The 31 - 35-year age group was the most frequent (31.4%; 44/144).

The majority of women (67.9%; 178/262) and men (53.4%; 140/144) were employed in the formal sector. Unemployment was reported among 28.2% (74/262) of women.

Regarding marital status, 44.3% (116/262) of women were living in cohabitation, 38.2% (100/262) were married, and 17.6% (46/262) were single. Among men, 51% (73/144) were cohabiting, 38% (55/144) were married, and 11% (16/144) were single.

Table 1. Sociodemographic characteristic of infertile couples at the ERHC (n = 262 women, n = 144 men).

The mean duration of the desire to conceive was 3.70 years. The mean number of sexual intercourses per week was 3.7, with 54.2% (142/262) of couples reporting 3 - 4 intercourses per week.

Table 2. Clinical and paraclinical characteristics of female partners suffering from couple infertility at the ERHC (n = 262).

The mean age at first sexual intercourse among women was 17.34 years.

A history of sexually transmitted infections was frequently documented. Chlamydia trachomatis infection was identified in 41.2% (108/262) of women, Mycoplasma infection in 18.3% (48/262), and Neisseria gonorrhoeae infection in 3.1% (8/262).

Primary infertility accounted for 64.1% (168/262) of cases, while 35.9% (94/262) presented with secondary infertility.

Female etiologies of infertility were dominated by tubal obstruction, observed in 56.5% (148/262) of cases, followed by uterine fibroids in 24.4% (64/262) and polycystic ovary syndrome in 15.3%.

Among the 144 male partners who participated in the evaluation, 77.8% (112/144) underwent semen analysis and spermocytogram, while 61.1% (88/144) had a sperm culture performed. Testicular ultrasound was conducted in 31.6% (46/144) of cases, revealing a limited number of varicocele diagnoses.

The most frequent sperm abnormalities were teratozoospermia in 13.9% (20/144) of cases and oligoasthenozoospermia in 11.8% (17/144).

Table 3. Clinical and paraclinical characteristics of male partners suffering from couple infertility at the ERHC (n = 144).

Based on the combined results of female and male investigations, infertility was attributed to a female factor in 47% of couples, a male factor in 32%, and mixed causes in 21% of cases.

Figure 1. Origine of couple infertility at the ERHC.

Couple infertility accounted for 14.16% of gynecological consultations at the Ebolowa Regional Hospital Center. This proportion confirms that infertility represents a substantial reason for gynecological consultation in this setting. Comparable frequencies have been reported in several African studies, including those from Mali, Nigeria, and Central Africa, with reported prevalences ranging from 12% to over 20% [2][5][7]. Variations across studies may reflect differences in study design, population characteristics, access to specialized care, and sociocultural perceptions surrounding infertility.

The relatively high frequency observed in our study may also be explained by the hospital’s role as a regional referral center, where couples with prolonged infertility are more likely to seek specialized evaluation.

The mean age of women (28.6 ± 4 years), with a predominance of the 26 - 30-year age group, is consistent with findings from other African series [2][5][7][8][13]-[15]. This age range corresponds to the period of optimal biological fertility, which likely explains the increased motivation to seek medical assistance when conception does not occur. Similarly, the most represented age group among men (31 - 35 years) reflects the common age gap between partners and has been reported in several comparable studies [2][7].

A notable finding is the high proportion of women engaged in formal employment and the predominance of cohabitation rather than formal marriage. Unlike settings where cultural or religious norms strongly link procreation to marriage, the sociocultural context of southern Cameroon allows greater acceptance of cohabitation, which may facilitate earlier presentation to health facilities for fertility concerns. These patterns contrast with studies conducted in predominantly Muslim or more traditional settings, where marriage is almost universal among couples seeking infertility care [16].

The mean duration of the desire to conceive (3.70 years) suggests that many couples delay seeking medical evaluation despite prolonged exposure to pregnancy risk. However, this duration remains slightly shorter than that reported in some Cameroonian studies [15], possibly indicating improved awareness or accessibility of reproductive health services in the region.

The reported frequency of sexual intercourse (approximately 3 - 4 times per week) is within the range considered adequate for natural conception, suggesting that infertility in this population is unlikely to be primarily related to insufficient sexual exposure. This finding supports the relevance of underlying biological and pathological factors.

Primary infertility predominated in this study, accounting for nearly two-thirds of cases. This pattern is consistent with several African studies [2][7], although contrasts with others where secondary infertility is more frequent, particularly in settings with high rates of obstetric complications, unsafe abortions, or untreated reproductive tract infections [7][13]. Differences in reproductive history, health-seeking behavior, and access to obstetric care may explain these discrepancies.

Female factors were the leading contributors to couple infertility in this study, accounting for 47% of cases. Among these, tubal obstruction was by far the most frequent etiology. This predominance is in line with numerous African reports and strongly correlates with the high prevalence of previous sexually transmitted infections, particularly Chlamydia trachomatis infection, identified in more than 40% of women in our cohort [2][5][7][8].

Uterine fibroids and polycystic ovary syndrome were also common findings, reflecting the growing burden of non-communicable gynecological conditions in African urban populations. The relative contribution of these etiologies varies widely across studies, depending on diagnostic capacity and population characteristics. Nonetheless, the central role of tubal pathology underscores the need for strengthened prevention, early diagnosis, and prompt treatment of sexually transmitted infections.

Male factors accounted for 32% of infertility cases, with sperm abnormalities such as teratozoospermia and oligoasthenozoospermia being the most frequently identified. This distribution is consistent with international literature, which recognizes sperm abnormalities as the leading causes of male infertility [19][20].

However, the true contribution of male factors may be underestimated in this study, given that only 55% of male partners participated in the diagnostic process. Cultural perceptions, stigma, and reluctance to undergo fertility evaluation remain major barriers to male involvement in infertility care in many African settings. Similar challenges have been described in studies from Cameroon and Mali. [2][5][8].

The presence of mixed infertility in 21% of couples highlights the multifactorial nature of infertility and reinforces the importance of a comprehensive, couple-centered approach to evaluation and management. Focusing exclusively on one partner risks overlooking contributory factors and delaying appropriate treatment.