Human infertility is a complex issue that has many consequences depending on the cultural context and lifestyle of those affected. It is defined by the World Health Organization (WHO) as the inability to achieve pregnancy after 12 months of unprotected intercourse in women younger than 35 or 6 months in women 35 or older [1]-[3]. Clinically, it is defined as at least one year of unintentional failure to conceive despite unprotected sexual activity throughout the fertile period of the menstrual cycle [4]. Infertility represents a real global public health problem, partly due to the complexity of its etiology and partly due to the difficulty of preventing and diagnosing it [2]. According to a new report published by the WHO, infertility affects approximately 17.5% of the adult population, or about one in six people worldwide. Sub-Saharan Africa has the highest infertility rate in the world [5], with 42% in West Africa, 30% in East Africa and 40% in South Africa, according to a study conducted by Abebe et al. in 2020 [6]. In Cameroon, the prevalence of infertility among couples was 19.2% according to a study conducted in 2020 by Egbe et al. [7], and according to a study conducted by Nana et al., female infertility accounts for 30% of all cases of infertility [8]. Pituitary hormones play a fundamental role in the reproductive process. Follicle-stimulating hormone (FSH) is necessary for the development and maturation of the gonads and for gamete production. It plays a key role in the development of astral follicles and, together with luteinizing hormone (LH), stimulates pre-ovulatory follicular growth [9]. Prolactin is the hormone responsible for lactation and has a significant impact on reproductive function [10]. Numerous dysfunctions occur during female infertility. These disorders can damage the fallopian tubes, disrupt ovulation or lead to hormonal complications [1][11][12]. The aim of this study was to investigate variations in pituitary hormones in patients with primary and secondary infertility.

We conducted a cross-sectional analytical study in the hospitals and clinics of Douala, Cameroon over a period of two years from November 2022 to November 2024.

At each hospital, patients attending gynecological consultations were approached after their medical records—provided by the gynecologist—had been reviewed and those who agreed were included in the study.

We recruited 145 infertile women from health facilities in the city of Douala.

The mean age in our study population was 33.1 ± 6.7 years, and the most represented age group was 30 - 35 years. This result is similar to that of a study conducted by Egbe et al. in Cameroon, in which the most represented population was 30 - 39 years old with an mean age of 30.1 ± 5.7 [7], and to that of Prasad et al. in India [13], which had 30 - 40 years as the most represented age group. Another study conducted in Cameroon by Kemfang et al. reveals that the mean age of the participants’ first pregnancy was 27.93 years [14]. This decline in age may be due to several factors, such as the increase in the level of education among women in our environment, the widespread participation of women in the workforce with the pursuit of careers and the search for professional stability before starting a family.

In the study population, 50.35% of women were from the grassfields region. This result is similar to that of Esther et al. in 2024 [15] in a study conducted in the city of Yaoundé, where 39.5% of the infertile women in their study were from the grassfields region. This result could be explained by the importance of motherhood in these cultures.

The mean duration of infertility found in our patients was 5.7 ± 4.7 years, with a minimum of one year and a maximum of 20 years. This result is similar to that of Ramezanzadeh et al. in Iran [16]. The duration of infertility between 1 - 3 years was the most common, at 44.83%. This result could be explained by the increase in consultations by couples seeking to conceive. Furthermore, some studies reveal that the duration of infertility between 2 - 3 years was associated with higher rates of depression and corresponded to the period of increased consultations by the couple [8].

The prevalence of primary infertility was 61.38% in the study population. 85.52% of the study population had used plant-based medicine as their first line of treatment for infertility. This result could be explained by the fact that infertility is conceived as much as a spiritual problem than as a medical issue which lead to the importance of cultural practices in managing infertility issues.

The study showed a statistically significant correlation between abnormal FSH (OR = 16; p = 0.0001) and LH (OR = 2.59; p = 0.02) values and patients aged 40 and over. In fact, patients aged 40 and over were 16 times more likely to have abnormal FSH concentrations and twice as likely to have abnormal LH values. This result is correlate with that of Al-Fahham et al. [12], who found a correlation between FSH variation and the age of the patients in his study. In her study, Voundi Voundi et al. found that age is a determining factor in infertility and the disorders it can cause [15]. The irregular nature of the menstrual cycle was statistically linked to abnormal FSH gonadotropin values (OR = 16.06; p = 0.008) and LH (OR = 2.42; p = 0.01). The risk of a patient with an irregular menstrual cycle having abnormal FSH levels was multiplied by 16 for FSH and by 2 for LH. Voundi Voundi et al. found that irregular menstrual cycles are a factor in changing hormone levels in infertile patients [15]. These results are the same as those found in the study conducted by Odiba et al. in Nigeria [17]. This could be explained by the fact that with age, there is a gradual loss of follicles and oocytes and a deterioration in gamete quality [18]. In addition, irregular menstrual cycles are often the result of a lack of ovulation, which can be caused by an imbalance in FSH and LH production, hindering normal follicle development and the onset of ovulation. In women, the hypothalamic-pituitary axis is controlled by positive or negative feedback depending on the stage of the cycle, so an irregular menstrual cycle hinders this regulation [19], which could lead to early menopause in women of childbearing age who have menstrual cycle disorders.

Prolactin levels were abnormal in 22.07% of cases, a result similar to that found by Al-Fahham et al. in 2016, who found abnormal prolactin levels in 18.18% of their study population [12]. A statistically significant correlation was found between abnormal prolactin levels and a relationship duration of ≤ 3 years. In fact, patients who had been in a relationship for less than 3 years were 3 times more likely (OR = 3.29; p = 0.01) to have abnormal prolactin levels. This result could be explained by the fact that abnormal prolactin level is the most common hormonal abnormality found in infertile women. In their study, Moussa D et al. found that 86% of women had abnormal prolactin levels [20]. Furthermore, the 1 - 3-year period corresponds to the period when couples wishing to have children increase their visits to the gynaecologist, thus enabling early diagnosis of hormonal variations.

There are several abnormalities in pituitary hormones during female infertility, one of the most significant determinants being age. According to WHO guidelines, age is the most important factor in predicting ovarian reserve. It is therefore essential to diagnose infertility as early as possible in order to address hormonal abnormalities.

In accordance with the declaration of Helsinki, a consent form was signed by every participant. Ethical clearance has been granted by the Institutional Ethics Committee for research on human health of the University of Douala (N˚3989 CEI-UDo/08/2023/T).

FKF, NMJP, CTN, and AD designed this study. FKF collected field data and performed laboratory analyses. FKF drafted the first version of the manuscript and analyzed and interpreted the data. NMJP also contributed to the interpretation of the data. AFTK, NMJP, CTN, HE, and AD reviewed the manuscript. AD supervised all stages of the work. All authors read and approved the final manuscript.

My sincere gratitude to the staff at the General Hospital and Laquintinie Hospital in Douala, particularly the staff at the clinical biology laboratory and the gynaecology department. I would also like to thank the staff at Douala Clinic, the staff at the Medical Surgical Centre and the Hope Centre.