J Infertil Reprod Biol, 2020, Volume 8, Issue 4, Pages: 84-89. https://doi.org/10.47277/JIRB/8(4)/84  
Menstrual Period and Anthropometric  
Characteristics of Women with Secondary  
Infertility and Age Matched Control  
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Adesola Ojo Ojoawo *, Olamide Oladoyin Bamidele , Stephen Olumide Akinsomisoye ,  
Babalola Adebanjo Adeyemi3  
1
Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo  
University, Ile Ife, Nigeria  
2
Department of Physiological Sciences, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo  
University, Ile Ife, Nigeria  
Department of Obstetrics and gynecology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University,  
Ile Ife, Nigeria  
3
Received: 26/08/2020  
Accepted: 05/11/2020  
Published: 20/12/2020  
Abstract  
The study investigated the anthropometric characteristics and menstrual cycle of women with secondary infertility and compared these  
with an aged matched control. Seventy six participants (38 women with secondary infertility and 38 aged matched fertile women  
participated in the study. The anthropometric parameters of weight, height, waist circumference (WC), hip circumference (HC), wrist  
circumference (WrC) and neck circumference (NC) were measured using standard protocol. Data was analyzed using IBM 23,  
descriptive and inferential statistics. Alpha level was set at 0.05. There was a significant difference in the body mass index of the women  
with secondary infertility and the control group (t = 4.642, p < 0.05). There was a significant difference in the waist-to-hip ratio (t =  
3
.496, p < 0.05) and waist to height ratio (t = 4.292, p< 0.05) of women with secondary infertility and the control group. There was also  
a significant difference in the average menstrual cycle length (t = 2.702, p < 0.05). There was a significant relationship between fertility  
and each of the anthropometric variables (p<0.05) except hip circumference. Those variables have a prediction of 54.8% and a predictive  
equation Y = 3.956 (Height) + 0.005(WC) +0.012 (NC) -0.216 (WrC)  0.018 (Weight)  1.076 was obtained. Women with secondary  
infertility carry more adiposity which contribute more that 50 % to the prediction of fertility and their menstrual cycle is longer than  
their fertile counterpart.  
Keywords: Infertility, Body Mass Index, Waist circumference, Neck circumference, Menstrual period  
Introduction  
Infertility is a very critical issue for couples of childbearing  
age all around the world, the incidence of infertility has been  
elevated significantly due to lifestyle changes and the presence  
of diverse environmental stress (1). It has recently been  
identified as the third most serious disease following cancer and  
cardiovascular pathologies (2, 3). Available data suggested that  
at least 50 million couples around the world experience  
infertility; which is defines as a failure to achieve clinical  
pregnancy after at least 12 months of unprotected coitus (4, 5).  
Primary and secondary infertility are the subtypes of  
infertility (6). Primary infertility in women has been described  
as a condition of being unable to get pregnant or to carry a baby  
to term as opposed to secondary infertility in women which has  
been described as the inability to carry a baby to term after a  
previous successful attempt (7). Roughly 2% of women aged  
between 20 to 44 years are unable to have their first life birth,  
secondary infertility are being underweight or overweight,  
physical inactivity, number of abortions; for men, staying up  
late at night frequently and engaging in high temperature  
occupations (1). Even though infertility is not a disease as it  
were, and its treatment impacts every aspect of people's lives,  
which can lead to diverse emotional and psychological  
consequences including turmoil, frustration, depression,  
anxiety, hopelessness, guilt, and feelings of worthlessness in  
life (9). Jordan and Ferguson (10) found out that infertile  
women have higher distress scores on the Patient Health  
Questionnaire than do other women in family practice clinics.  
Body Mass Index (BMI) and waist circumference (WC) are  
two common anthropometric measures of obesity in clinical  
and public health practice (11). It is known that as waist-to-hip  
ratio (WHR) and body mass index increase, there is a higher  
risk of suffering from diseases ranging from hypertension to  
diabetes, cancer, depression and fertility problems (12). Waist  
to height ratio (WHtR) has been found to be simple, rapid and  
more sensitive screening tool when compared to BMI (13, 14).  
Measures of frame size (FRS) has been proven to be  
significantly and positively correlated with fat free mass, body  
fatness, bone mass and body weight at all ages (15).  
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0.5% of women around the world experience secondary  
infertility (4). Elevated levels of secondary infertility occur in  
countries of Sub-Saharan Africa ranging from 5% in Togo to  
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3% in Central African Republic (8).  
The main risk factor for primary infertility is high or  
extremely low body mass index while the risk factor for  
*
Corresponding author: Adesola Ojo Ojoawo, Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of  
Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria. Email: adesolaojoawo@gmail.com  
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J Infertil Reprod Biol, 2020, Volume 8, Issue 4, Pages: 84-89. https://doi.org/10.47277/JIRB/8(4)/84  
Wrist circumference (WrC) is one of the most reliable  
measurements to assess body frame size through Grant index  
The sample size was rounded up to 70 (35 for each group) to  
accommodate for possible attrition.  
(
height in cm/ WrC in cm) (16).  
Neck circumference (NC) has been recently been used to  
Research design  
identify overweight and obesity and is observed to correlate  
with age, weight, waist and hip circumferences, waist-to-hip  
ratio and body mass index (17).  
There is a dearth of studies that explore difference between  
anthropometric characteristics, especially frame size and neck  
circumference, which objectively measures the body  
composition, of women with secondary infertility compared to  
other women without the condition. This study aims to  
compare anthropometric parameters of women with secondary  
infertility with age matched control.  
This work was a cross sectional study.  
Procedure  
The ethical approval for this study was obtained from the  
Ethics and Research Committee of Obafemi Awolowo  
University Teaching Hospitals Complex (OAUTHC)  
(
ERC/2019/09/25). The participants were fully informed about  
the purpose of the study and their consents were obtained  
before commencement of the measurements. Thirty eight  
women with secondary infertility were recruited for the  
Outpatient Obstetrics and Gynecology Clinic, OAUTHC, Ile  
Ife, Nigeria.  
Considering the aged matched control group, for a subject  
with specific age, three women of the same age were approach  
for each patient of a certain age i.e if a subject is 30 years old,  
three fertile women of 30 years old that gave their consent to  
participate in the study were searched for. One out of those  
three was randomly picked as the age matched participants for  
the study. This was done to recruit thirty eight age matched  
fertile women for the study  
Materials and methods  
Participants  
Women with secondary infertility and the age matched  
fertile women attending out patients Obstetrics and  
Gynecology Clinic, at the Obafemi Awolowo University  
Teaching Hospitals Complex, Ile Ife. The control group  
consisted of aged matched fertile women within the same  
vicinity  
Inclusion criteria  
Fertile women between the ages of 20-45 years were included  
in the study. Women with inability to get pregnant or carry a  
baby to term for at least 12 months after a previous successful  
attempt without protected coitus between the ages of 20-45  
years.  
Anthropometric data were obtained for both the patents  
and age matched control using the procedures according to  
Marfell-Jones et al. (19)  
The height was measured with a height meter. Participants  
were asked to stand barefooted on the platform of the scale  
looking straight ahead while the horizontal bar attached to the  
height meter was adjusted to touch the vertex of the head.  
Weight was measured on a weighing scale with the participant  
in minimal clothing, barefooted and standing in an erect posture  
looking straight ahead.  
Exclusion criteria  
Women with secondary infertility with significant co-  
morbidities such as diabetes and hypertension were excluded  
from the study.  
Instruments  
Waist circumference was measured with an anthropometric  
tape measure. Participants were in standing position. The  
participants wore little clothing so that the tape may be  
correctly positioned. Clothing was restricted to light underwear  
that would not affect the measurement. The participant stood  
erect with the abdomen relaxed, the arms by the sides and the  
feet together. The measurer faced the measured at the level of  
the natural waist in horizontal plane which is the narrowed part  
of the waist which is the narrowest part of the torso as seen from  
the anterior aspect. The measurement was taken at the end of  
normal expiration. The recorder walked round the participant  
to make sure that the tape is parallel to the floor and that the  
tape is snug, but did not compress the skin. The measurement  
was made at minimal respiration to the nearest 0.1cm.  
Hip circumference was measured using the anthropometric  
tape measure. The participant was asked to stand erect with feet  
together and weight evenly distributed on both feet. The  
participants were on light clothing. The examiner squatted on  
the right side of the participant and places the tape rule around  
the hip. The tape was placed at the maximum extension of the  
buttocks. The examiner then adjusted the tape and checked the  
front to ascertain that the plane of the tape was horizontal. The  
zero end of the tape was held under the measurement value. The  
tape was held snug but not tight. The examiner took the  
measurement from the right side and recorded the measurement  
to the nearest 0.1cm.  
The following instruments were used in the study weighing  
scale (seca model 7621019008, Germany); Height meter (Seca  
model 222, Germany) and Tape measure, (0.7cm wide butterfly  
made from China)  
Sampling technique  
Purposive sampling technique was used to recruit subjects for  
this study.  
Sample size determination  
According to (Rosner, (18) this equation can be used for a study  
comparing two means  
N= 4S.D (Zcrit + Zpwr)2  
2
2
D
Where N is the total sample size (the sum of the sizes of both  
comparison groups),  
S.D is the assumed standard deviation of each group and this  
assumed to be 15.  
Z
crit is the standard normal deviate corresponding to selected  
significance criterion = 1.96  
pwr is the standard normal deviate corresponding to selected  
Z
statistical power (i.e 0.8)  
D is the minimum expected difference between the two means  
and is assumed to be 10.  
Therefore,  
Neck circumference was taken in a plane as horizontal as  
possible, at a point just below the larynx (thyroid cartilage) and  
perpendicular to the long axis of the neck (the tape line in front  
of the neck at the same height as the tape line in the back of the  
2
2
N= 4 x 15 (1.96 + 0.8)  
2
1
0
N= 68.5584  
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J Infertil Reprod Biol, 2020, Volume 8, Issue 4, Pages: 84-89. https://doi.org/10.47277/JIRB/8(4)/84  
neck). While taking this reading the subject was asked to look  
straight ahead, with shoulders down, but not hunched. Care was  
taken not to involve the shoulder/neck muscles (trapezius) in  
the measurement. Wrist circumference was measured with  
participant in a seated position using a tension-gated tape  
measure positioned over the Lister tubercle of the distal radius  
and over the distal ulna. The Lister tubercle, a dorsal tubercle  
of the radius, was palpated at the dorsal aspect of the radius  
around the level of the ulna head, about 1 cm proximal to the  
radiocarpal joint space.  
Comparison anthropometric  
measurements of subjects and control group  
Displayed in table is the comparison between the  
between  
the  
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anthropometric features of the subjects and the control group.  
There was a significant difference in the weight (t =2.451,  
P<0.05) and the height (t=2.993, P< 0.05) of the subjects and  
the control group. There was also a significant difference in the  
body mass index (t=4.642, P< 0.05). However, there was no  
significant difference in the hip circumference of the subjects  
and the control group (t =1.148, P> 0.05). Other parameters are  
outlined in table 2 below.  
Period in days between the date of the last menstrual circle  
and the beginning of the other one were recorded for the last  
three months for the subjects and normal individuals. These  
were provided by the participants.  
Comparison between the average menstrual cycle  
length of the subjects and control group  
There was a significant difference between the average  
menstrual cycle length of the subjects and control group (t =  
Data analysis  
Data was analyzed using the descriptive statistics of mean  
and standard deviation. Inferential statistics of independent t-  
test was used to assess the difference between anthropometric  
characteristics and menstrual cycles of women with secondary  
infertility and the control group. Spearman Rho was used to  
assess the relationship between anthropometric variables and  
fertility types. Regression analysis was used to derive equation  
for the prediction of fertility. The alpha level was set at 0.05.  
The data analysis was carried out using SPSS IBM version 23  
software.  
2.702, P< 0.05). There was also a significant difference in the  
first menstrual cycle of both groups (t = 2.505, P< 0.05).  
However, a difference was noted in the last two menstrual cycle  
lengths but not statistically significant.  
Shown in table 3 is the relationship between fertility and  
anthropometric variables.  
There was a significant relationship between fertility and  
each of all the anthropometric variables (P < 0.05) under  
consideration except hip circumference (P>0.05).  
The prediction of fertility using anthropometric variables is  
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shown in table 4a and b. The R is 0.548 indicating that all the  
Results  
variables have a contribution of 54.8% to the prediction of  
secondary fertility of a woman.  
Physical characteristics of subjects  
Shown in Figure  
1
is the summary of physical  
The derived equation is Y = K+ aX+ bZ where K is the  
constant and X and Z are the anthropometric variables. The  
equation is Y = 3.956 Height + 0.005 (Wc) +0.012 (NeckC) -  
0.216 (WrC)  0.018 (Weight)  1.076: W = waist, C=  
circumference.  
characteristics of the subjects. The mean weight for the subject,  
control and total were 70.28 ± 10.54 kg, 62.31 ± 7.61kg and  
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6.30 ± 9.91 kg respectively. The mean body mass index were  
8.48 ± 4.22 kg/m , 23.07 ± 1.99 kg/m and 25.77 ± 4.25 kg/m  
2 2 2  
for the subjects, control and total participants respectively.  
Physical characteristics of all the Participants T  
1
20  
00  
1
80  
60  
40  
20  
0
Age  
Weight  
Height  
BMI  
WC  
HC  
NC  
WrC  
FRS  
WHR  
WHtR  
Subjects  
Control  
Total  
Figure 1. Chart representing the Physical Characteristics of all the participants. Key: BMI: Body Mass Index, WC: Waist  
Circumference, HC: Hip Circumference, WrC: Wrist circumference, NC: Neck Circumference, FRS: Frame Size, WHR: Waist  
to Hip Ratio, WHtR: Waist to Height Ratio.  
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