Patterns of lipids and estrogen in women visiting the fertility clinic of Komfo Anokye Teaching Hospital, Kumasi, Ghana

Joseph Sarfo Antwi, Kweku Bedu Addo, Frank Ankobea Krokoe


Background: Infertility, which affects one in six couples, is a major clinical and social problem. Pelvic inflammatory diseases (PID) and sexually transmitted infections are but two of the several causes of infertility. The influence of lipid patterns and estrogen on infertility in the setting is however not fully explained. Therefore, the study sought to establish the Patterns of lipids and estrogen among infertile women visiting Komfo Anokye Teaching Hospital, Kumasi.

Methods: The design was both retrospective and introspective study. Sampling technique was convenience and random probability sampling using a list of women with fertility challenges who attended KATH for infertility treatment. Univariable associations were tested using chi-square and a logistic regression was performed to assess the influence of lipids and estrogen on infertility. Associations were considered significant at p values of <0.05.

Results: BMI was significantly associated with fertility in this study. The percentage of respondents who were overweight and obese was significantly higher among the women who were non-fertile as compared to those who were in the control group ((81.4% vrs 18.6% and 84% vrs 16% respectively). An increase in LDL cholesterol and total cholesterol were associated with increased likelihood of infertility among the subjects (OR, 95% CI=4.34, 2.18-8.65) and (OR, 95% CI=1.86, 1.03-3.35) respectively. A unit increase in BMI of the women is associated with 13% increase in the odds of being infertile, (OR, 95% CI=1.13, 1.01-1.65).  A unit increase in estrogen level was also associated with 11% decrease in the odds of becoming infertile among the women studied (OR, 95% CI=0.89, 0.85-0.92).

Conclusions: This study shows the influence of body mass index and high cholesterol levels on infertility. This finding will be useful in directing educational interventions aimed at promoting healthy lifestyles to reduce lipid levels and improve fertility among women.


BMI, Cholesterol, Estrogen, Fecundity, Infertility

Full Text:



Baird DD, Wilcox AJ, Weinberg CR. Use of time to pregnancy to study environmental exposures. Am J Epidemiol. 1986;124:470-80.

Joffe M. Time to pregnancy: a measure of reproductive function in either sex. Occup Environ Med. 1997;54:289-95.

Tietze C. Statistical contributions to the study of human fertility. Fertil Steril. 1956;7:88-95.

Tietze C. Fertility after the discontinuation of intrauterine and oral contraception. Int J Fertil. 1968;13:385-9.

Tuntiseranee P, Olsen J, Chongsuvivatwong V, Limbutara S. Fecundity in Thai and European regions: results based on waiting time to pregnancy. Hum Reprod. 1998;13:471-7.

Spira A. Epidemiology of human reproduction. Hum Reprod. 1986;1:111-5.

Kamel RM. Management of the infertile couple: an evidence-based protocol. Reproduct Biol Endocrinol. 2010;8(1):1.

Geelhoed DW, Nayembil D, Asare K, Schagen van Leeuwen JH, Van Roosmalen J. Infertility in rural Ghana. Int J Gynecol Obstet. 2002 Nov 1;79(2):137-42.

Poppe K, Velkeniers B. Thyroid and infertility. Verhandelingen-Koninklijke Academie voor Geneeskunde van Belgie. 2002;64(6):389-99.

Razzak AH, Wais SA. The infertile couple: a cohort study in Duhok, Iraq. Est Mediterr Health J. 2002;8(2-3):234-8.

Ikechebula JI, Adinma JI, Orie EF, Ikegwuonu SO. High prevalence of male infertility in Southeastern Nigeria. J Obstet Gynecol. 2003;23(6):657659.

Araoye MO. Epidemiology of infertility: social problems of the infertile couples. West Afr J Med. 2003;22:190-6.

Tolstrup IS, Kjaer SK, Hoist C, Sharif H, Munk C, Osier M. Alcohol use as predictor for infertility in a representative population of Danish women. Acta Obstet gynecol Scand. 2003 Aug 1;82(8):744-9.

Saleh RA, Agarwal A, Sharma RK, Nelson DR, Thomas AJ Jr. Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: A prospective study. Fertil Steril. 2002;78(3):491-9.

Irvine S. Guidelines in the treatment of male infertility. Int Cong Series; 2004;1266:202-7.

Esimai OA, Orji EO, Lasisi AR. Male contribution to infertility in Nigeria. Niger Med. 2002;11(2):70-2.

Olatunji AO, Sule-odu AO. The pattern of infertility cases at a university hospital. West Afr J Med. 2003;22(3):205-7.

Bayasgalan G, Naranbat D, Tsedmaa B, Tsogmaa B, Sukhee D, Amarjargal O et al. Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynaecol Res. 2004;30(5):386-93.

Speroff L, Glass RH, Kase NG. Female infertility. In Clinical Gynecologic Endocrinology and Infertility. 6th edition. Lippincott Williams & Wilkins, Philadelphia, PA, USA;1999.

Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin Endocrinol, Diab Obesity. 2007;14(6):482-7.

Cahill DJ, Prosser CJ, Wardle PG, Ford WC, Hull MG. Relative influence of serum follicle stimulating hormone, age and other factors on ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol. 1994;101:999-1002.

Brosens I, Gordts S, Valkenburg M, Puttemans P, Campo R, Gordts S. Investigation of the infertile couple: when is the appropriate time to explore female infertility?. Human Reprod. 2004 Aug 1;19(8):1689-92.

Omberlet W. Global access to infertility care in developing countries: a case of human rights, equity and social justice. FVV Obstet Gyn. 2012:7-16.

Baskind NE, McRae C, Sharma V, Fisher J. Understanding subfertility at a molecular level in the female through the application of nuclear magnetic resonance (NMR) spectroscopy. Human Reproduction Update. 2011;17(2):228-41.

Kirkwood B, Sterne J. Essential Medical Statistics, 2nd Edition Blackwell Publications, USA;2003

World Health Organization. Working group on infant growth. An evaluation of infant growth: the use and interpretation of anthropometry in infants. Bull World Health Organization. 1995;73:165-74.

World Health Organization (2006). Global Database On Body Mass Index, Retrieved. 2012.

Brezina PR, Vlahos NF, Lai TH, Garcia JE, Wallach EE, Zhao Y. The impact of luteal phase support on endometrial estrogen and progesterone receptor expression: a randomized control trial.Reprod Biol Endocrinol. 2012 Feb;10:16.

Jefferson WN. Adult ovarian function can be affected by high levels of soy. J Nutr. 2010;140(12):2322S-2325S.

Usoro CC, Adikwuru CAO. Lipid profile of postmenopausal women in calabal Nigeria. J Nutri. 2006;5(1):79-82.

Schisterman EF, Munford SL, Brown RW, Barr DB, Chen Z, BuckLouis GM. Lipid Concentrations and Couple Fecundity. LIFE Study. 2014;99(8):2786-94.

Lloyd GER (Ed.) 1978 Hippocratic writings. London: Penguin Books.

van der Steeg JW, Steures P, Eijkemans MJ, Habbema JD, Hompes PG, Broekmans FJ, CECERM study group (Collaborative Effort for Clinical Evaluation in Reproductive Medicine). Pregnancy is predictable: a large-scale prospective external validation of the prediction of spontaneous pregnancy in subfertile couples. Hum Reprod. 2007;22(2):536-42.

Rich-Edwards JW, Goldman MB, Willett WC, Hunter DJ, Stampfer MJ, Colditz GA. Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol. 1994 Jul;171(1):171-7.

Grodstein F, Goldman MB, Cramer DW. Body mass index and ovulatory infertility. Epidemiology. 1994;5:247-50.

Hassan MAM, Killick SR. Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril. 2004;81:384-92.