Etiology of Primary Subfertility in Women Presenting to Tertiary Care Hospital

Introduction: Failure to conceive after one year of regular unprotected intercourse is a common and agonising event in young women of childbearing age and is referred to as primary subfertility. The causes are diverse and they include ovulatory dysfunction and tubal disease, endometriosis, uterine anomalies and infertility. Objective: To determine etiological factors of primary subfertility in women attending a tertiary care hospital. Material and Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Civil Hospital Karachi, Pakistan from April, 2024 to September, 2024. One hundred and sixty women between 18 and 40 years of age with primary subfertility were recruited using non-probability consecutive sampling. Etiological factors were identified through a detailed history, clinical examination, hormonal evaluation, ultrasound, hysterosalpingography, and diagnostic laparoscopy. Descriptive statistics were calculated to analyse the data. Results: The prevalent cause was ovulatory dysfunction (35.6 per cent), followed by tubal factor infertility (26.3 per cent), unexplained infertility (15.6 per cent), endometriosis (12.5 per cent), and uterine abnormalities (10.0 per cent). Abnormalities in the hormones were high LH (22.5%), thyroid dysfunction (11.3%), hyperprolactinemia (8.1%), and high FSH (6.3%). Conclusion: Tubal factors and ovulatory disturbance continue to be the commonest etiologies of primary subfertility. A complete and early assessment with minimally invasive laparoscopy is necessary to maximise the chances of diagnosis and enhance reproductive outcomes.