Infertility Predictors at Asella Referral & Teaching Hospital, Ethiopia: A Case-Control Study

Introduction: Infertility is a global reproductive health challenge, defined as the failure to achieve pregnancy after 12 months of regular unprotected intercourse. In Ethiopia, where motherhood is central to social identity, infertility often leads to significant social stigma and marital instability. This study aimed to identify the socio-demographic and clinical determinants of infertility among women in Asella, South-East Ethiopia. Methods A facility-based matched case-control study was conducted at Asella Referral and Teaching Hospital (ARTH) from May 30 to December 30, 2024. A total of 405 participants (135 cases and 270 controls) were enrolled. Data were collected via structured interviews and managed through a double-entry protocol in Epi-Data 4.6. To ensure data reliability, a sensitivity analysis was performed to assess recall bias. Data were analyzed using SPSS version 27.0. Predictors were identified using conditional multivariable logistic regression, with significance set at p < 0.05. Results The mean age of participants was 27.53 ± 5.13 years, with secondary infertility being the predominant type (74.8%). Multivariable analysis revealed that formal education was the strongest predictor (AOR = 10.51; 95% CI: 4.18–26.41), followed by a history of gynaecological procedures (AOR = 7.34; 95% CI: 3.32–16.49). Women aged ≥ 30 years had nearly five times higher odds of infertility (AOR = 4.95,p < 0.001). Other significant risk factors included rural residency (AOR = 3.22), cyclic menstrual pain (AOR = 3.18), age at menarche ≥ 14 years (AOR = 2.69), and no prior use of family planning (AOR = 2.21). Aged menarche ≥ 14 years (AOR = 2.69), and no history of family planning use (AOR = 2.21). Conclusion Infertility in the Arsi Zone is a dual-natured crisis driven by biological aging among educated women and preventable clinical factors among rural populations. The strong association with prior gynaecological procedures and the high prevalence of secondary infertility point toward a need for improved surgical safety and post-operative care. Interventions should focus on enhancing reproductive health awareness and clinical standards in South-East Ethiopia.