Awareness and perception of assisted reproductive technology practice amongst women with infertility in Northern Nigeria

doi:10.4236/ojog.2011.13027

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Open Jo urnal of Obstetr ics and Gynecology, 2011, 1, 144-148 OJOG

doi:10.4236 /ojog.2011.13027 Published Online September 2011 (http://www.SciRP.org/jo urnal/ojog/).

Published Online September 2011 in SciRes. http://www.scirp.org/journal/OJOG

Awareness and perception of assisted reproductive technology

practice amongst wome n with infertility in Northern Nigeria

Adebiyi Gbadebo Adesiyun*, Nkeiruka Ameh , Solomon Avidime, Abdulsalam Muazu

Department of Obstetrics Gyna ecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

E-mai l : *

HHUU[email protected]UUHH

Received 20 April 2011; revised 26 April 2011; acce pt e d 5 A ug us t 2011.

ABSTRACT

Background: Involuntary infertility is a tragedy in

most African setting. This is due to premium placed

on fertility as a result of roles children fulfill in the

family and the socie ty. Aetiologic factors of infertility

in sub-Saharan Africa are mostly infection related

and they are mainly associated with poor treatment

outcome to conventional non assisted conception

technique. Objective: To evaluate the level of aware-

ness and perception of assisted conception treatment

among women attending fertility clinic. Methods: A

descriptive cross-sectio nal study. Results: One hun-

dred and ninety six women attending fertility clinic

were interviewed. Mean age was 34.8 years a nd mean

duration of infertility of 4.1 years. Of the 196 infertile

women interviewed, 150 (76.5%) have heard of As-

sisted Reproductive Technology treatment. Sources

of information were mainly family relation (46%)

and friends (28.7%). Knowledge on some of Assisted

Reproductive Technology practices showed that

50.7% were aware that the treatment could fail,

36.8% knew it could be applied for male infertility

treatment, 9.3% and 18.7% respectively are aware

that do nor oocyte and sperm coul d be used for tre at-

ment. Perception on babies conceived from assist ed

conception treatment revealed that 52% of patients

interviewed could not comment if they are normal

and natural babies. Majority of patients could not

affirm if they will agree to the use of donor ga mete or

zygote for their treatment. Conclusio n: Aw areness of

assisted conception treatment was high, however

knowle dge on spec ifics of trea tment w as low a nd per-

ception on some of the practices was unfavorable.

Sensitization of the public will help overcome some

beliefs that may be at tangent to some practices of

assisted co nc e ption.

Keywords: Awareness; Perception; Infertility; Assisted

Reproductive Technology

1. INTRODUCTION

In sub-Saharan Africa, about one-third of couples are

reported to be infertile [1] . Female infertility was re-

ported to a ccount for about 5 5% of infertilit y cases, male

factor for about 30% to 40% of cases and unexplained

infertility accounted for the remaining 5 to 15 percent [2,

3,4]. In most African setting, parenthood is culturally

mandatory and childlessness is socially unacceptable;

this is beca use c hil d re n ar e hi ghly des i re d ad d iti o n to the

family and the society [5]. The repercussions of inferti-

lit y go b e yo nd ‘ no t j ust ha vi n g a chil d of yo ur o wn ’. I t is

associated with incomprehensible and immeasurable

psychological and social consequences which impact

more on the female. In Africa, infectio n is the most com-

mon cause of infertility [2,6]. Sexually transmitted in-

fections mainly from gonorrhoea and Chlamydia, and

pregnancy related infections d uring or after abortion and

childbirth are the main culprit. In Africa, infections re-

sulting in tubo-peritoneal factor and oligo-azoospermia

are the two leading causes of infertility [2,3,4 ] . The

place of tubal surgery versus IVF (in vitro fertilization)

in the treatment of tubal infertility showed that patients

are optimally treated with IV F [7]. A st udy fr om Nigeria,

reported an estimate of 30 to 40 percent of patients with

tubal factor infertility would need ART (assisted repro-

ductive tech no logy) treatment [ 8 ].

Assisted Reproductive technology has been reported

to relieve more than 50 percent of infertility cases [9].

However, to set up this technology in the developing

world is capital intensive and to access the treatment is

reciprocally expensive. These pose barrier s to the spread

of ART treatment in the developing world where this

technology is mostly needed. On the contrary, in the de-

veloped countries, ART treatment has made substantial

contribution to the alleviation of infertility burden. In

Latin America and Egypt, the proportion of the popula-

tion that have access to ART treatment is less than 2

percent, while rates as high as 37 p ercent have access to

ART treat ment in Denmark [9]. Deter mining the level o f

A. G. Ad e s i yu n et al. / Open Journal of Obstetrics and Gynecology 1 (20 11) 144-148

145

awareness and perception on ART treatment practises

among infertile women would be useful in sensitizing

and planning public enlightenment programmes on ad-

vanced infertility treatment. We hypothesize that the

constraints of lo w sp read of ART treatment option in the

developing countries may have a negative impact on

knowledge and perception on ART treatment.

2. PATIENTS AND METHODS

This was a descriptive cross-sectional study carried out

in two public hospitals (Ahmadu Bello University

Teaching Hospital, Zaria and 34 5 Aero medical Hospital,

Kaduna) and one cosmopolitan multidisciplinary private

hospital (Alba hospital, Kaduna), all located in Kaduna

state, Northern Nigeria. All consenting infertile women

that attended the infertility clinic between July 2006 to

March 2007 and May to October 2010 were interviewed

in accordance with the questions on a pre-tested de-

signed questionnaire. Women who have undergone ART

treatment before were excluded from the study. For this

study, infertility was defined as inability of a couple to

conceive despite one year of unprotected sexual inter-

course. In this study in-vitro fertilization popularly

known as ‘Test-tube baby technology’ was used as re-

ference to ART.

The patients were personally interviewed by the doc-

tors running the infertility clinic. Protection of subjects

right s in ter ms of ano nymity a nd confi dentiali ty was e n-

sured. The easy-to-use questionnaire include section on

socio-demographic characteristics, type of infertility,

source of ART information, affordability of ART treat-

ment, knowledge on some ART practices, perception on

ART conceived babies and attitude donating and use of

donor ga mete and zygote.

3. RESULTS

One hundred and ninety six wome n with the diagnosis of

infertility were interviewed for this study and 150 of

them have heard o f ART. This gives an awareness rate of

76.5%. Analysis of the 150 patients that have heard of

ART showed t hei r mean age to be 34.8 year s with an age

range of 18 to 46years. Mean duration of infertility was

4.1 years with a range of 12 to 144 months. Of the 150

patients, 123 (82.0%) had secondary infertility and 27

(18.0%) presented with primary infertility. When asked

about the first source of ART infor mation, 69 (46%) pa-

tient s heard fro m fa mily relation, 43 (28.7%) from friend,

27 (18%) from health facility, 6 (4.0 %) thr o ug h t he ma s s

media and the remaining 5 (3.3%) patients could not

remember the source of information. Should an ART

treatment cycle cost 4000 United Sates dollars, only 4

(2.7%) patients of the 150, said they can afford the

treatment Table 1.

Table 1. Demographic characteristics and source of ART in-

formation.

CHARACTERIS TICS / SOURCE OF

INFOR MATION

DATA N =

150

AGE (years)

Mean and r ange 34.8 (18 – 46)

HIGHEST LEVEL O F EDUCATION n (%)

Illiterate 28 (18.7)

Primary 34 (22.7)

Secon dary 66 (44.0)

Post sec ondary 11 (14.7)

OCCUPATION n (%)

Unskilled workers 62 (41.3)

Semi skilled workers 66 (44.0 )

Skilled workers 13 (8.7)

Professional 9 (6.0)

TYPE OF INFERTILITY n (%)

Primary 27 (18.0)

Secon dary 123 (82.0)

SOURCE OF ART INFORMATION n (%)

Family relation 69 (46.0)

Friends 43 (28.7)

Health facility 27 (18.0)

Mass media 6 (4.0)

Others 5 (3.3)

AFFORDABILITY OF ART TREATMENT n

(%) 4 (2.7)

ART- Assisted Repr oductive Technology.

Knowledge about ART practice revealed that 76

(50.7%) of the 150 patients knew that ART treatment

could fail to produce pregnancy, also 54 (36.8%) patients

were aware that ART could be applied in the manage-

ment of male infertility. Of the 150 patients, 14 (9.3%)

and 28 (18.7%) patients knew that donor oocyte and

sperm could be used for treatment in ART procedure.

Only 2 (1.3%) patients had kno wledge on the use of do-

nor zygote. Awareness on cryop reservatio n revealed that

28 (18.7%) patients know that oocyte and sperm can be

preserved for future use while only 2 (1.3%) of the 150

patients were aware of ovarian and testicular tissue pre-

servation Table 2.

Patients perception of babies conceived through ART

sho wed tha t 28 (18.7%) of the 150 patients vie w them a s

naturally normal babies, 21 (14%) view them as normal

but not natural babies, 22 (14.7%) view them as not na-

turally normal babies, while the remaining 79 (52.7%)

patients do not know how normal and natural such ba-

bies are. However, when asked if they would undergo

ART treatme nt should it be affordable and the only solu-

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146

Table 2. Knowledge of some ART practice.

KNOWLEDGE DATA (N = 150)

ART failure n (%) 76 (50.7%)

ART for male infertility treatment n (%) 54 (36.8)

Use of donor oocyte n (%) 14 (9.3)

Use of donor s perm n (%) 28 (18.7)

Use of donor zygote n (%) 2 (1.3)

Preservation of ga m ete n (%) 28 (18.7)

Preservation of ova rian tissue n (%) 2 (1.3)

Preservation of ti s sue n (%) 2 (1.3)

ART- Assisted Repr oductive Technology.

tion to having their own baby, 138 (92%) said Yes and

the remaining 12 (8.0%) do not know. On the possible

use of donated oocyte for their ART treatment, 44

(29.3%) said Yes to its use, 9 (6.0%) said No to its use

while 97 (64.7%) patients do not know if they will use

oocyte from a donor for ART treatment. Concerning

donated sperm to fertilize their oocyte, 27 (18.0%)

would not mind the use of donor sperm, 5 (3.3%) will

not co nsent to use of donor sperm while the remaining

118 (78.7%) patients do not know if t hey will conse nt to

use of donated sperm. When asked about the possible

use o f donor zygote for ART treat ment, 11 (7.3%) of the

150patients will agree to use it, 62 (41.3%) will not

agree, and 77 (51.3%) do not know if they will use do-

nated zygote. Patients were asked if they will be willing

to donate their oocyte for someone else use, 63 (42.0%)

said Yes, 11 (7.3%) said No and 76 (50.7%) do not know.

Ta ble 3.

4. DISCUSSION

A major challenge to ART especially in developing

countries is how to make the technology accessible with

reference to availability and affordability. The World

Collaborative Report on IVF revealed a satisfying spread

of ART in the developed countries; however the same

cannot be said in the developing countries where the

need for this technology is highest [10]. Nigeria has a

population of 150 million with only about 15 ART cen-

tres that are mainly privately owned. In this study, it is

not surprising that about three percent of the surveyed

population could afford a treatment cycle even though

majority wo uld like to undergo ART treatment if recom-

mended. Similar survey among infertile women in Mali,

West Africa sub-region reported 78.9 percent were ready

to resort to ART but only 24.9 percent would be able to

mobilize the required resources [11 ]. In Nigeria, the

minimum monthly wage of public worker is about 100

United States Dollar. In an international survey, about

seventy percent felt that IVF treatment should be re-

Table 3. Percerption of ART conceived babies and use of do-

no r gamete/zygote.

PERCEPTION DATA N = 150

ART CO NCEIVED BABIES n (%)

Normal and natural babies 28 (18.7)

Nor m a l but no t na t ural babies 21 (14.0)

Not nor m al a n d not natural 22 (14.7 )

Do not know 79 (52.7)

USE OF DONOR SPERM n (%)

Yes 27 (18.0)

No 5 (3.3)

Do not know 118 (79.7)

USE OF DONOR OOCYTE n (%)

Yes 44 (29.3)

No 9 (6.0)

Do not know 97 (64.7)

USE OF DONOR ZYGOTE n (%)

Yes 11 (7.3)

No 62 (41.3)

Do not know 77 (51.3)

DONATION OF OOCYTE/ SPERM n (%)

Yes 63 (42.0)

No 11 (7.3)

Do not know 76 (50.7)

imbursable by the government [12]. In the developing

countries reimbursement for fertility treatment has not

been in practice due to financial constraints and insensi-

tivity to the plight of the infertile couple. For those un-

familiar with the burden and consequences of infertility

in the sub -Saha ra n Afric a, i t i s not unus ual t o as k fo r the

justification to use scarce resources to provide more

offspring to a n already overpopulated setting bemoan by

high materna l, p erinata l, infa nt a nd unde r five child hood

mortality mainly from preventable causes.

With IVF as a reference, about seventy percent of the

pop ul ati o n have hea rd o f the t ec hno lo g y. T his i s hig h b ut

not unexpected because the study was carried out in ur-

ban setting a nd infact the perception that ART is the so-

lution to hitherto ‘hopeless’ cases may have helped pro-

pagate the awareness. Knowledge of failure rate was

known by half of infertile women surveyed. This is an

important factor in ART treatment, especially in the de-

veloping counties where the treatment is privately

funded in the midst of lack. Similar survey among the

gener al population in E urope and the U .S showed t hat 90

percent knew of IVF, but less than 25 percent knew

about the chances of s ucces s [12]. Studi es have sho wn a

positive relationship between IVF failure and emotional

A. G. Ad e s i yu n et al. / Open Journal of Obstetrics and Gynecology 1 (20 11) 144-148

147

trauma [13] and increased level of anxiety and depres-

sion that negatively impacts on their life [14,15]. Treat-

ment of male infertility in this sub-region is of para-

mount importance because the often domineering male

par tners do confuse sexual potenc y with fe rtility c apabi -

lity there by transferrin g the bla me to the woman in most

situations. This study showed that 36 percent of the

women knew that ART could be applied for treatment of

male infertility. This figure is low considering that male

infertility due to oligospermia is the second common

cause of infertility in Africa after tubo-peritoneal factor

[2,3,4]. Knowledge on the use of donor gamete and zy-

gote and their preservation was low in this study. This

may not be unrelated to the rarity of ART treatment in

this part of the world and the depth and correctness of

the patient’s source of ART information which was

mainly from family relation and friends in this study. In

contrast to an Iranian study that reported ART centre as

the source of information among their infertile women,

thereby exposing them to acc urate and detailed informa-

tion [16].

Respo nse from this study showed that perception on

ART babies and use of donate d gametes and z ygotes for

their ART treatment was mainly. I do not know by pa-

tients. This response may be interpreted as uncertainty

and ignora nce sur rounding ART tre atment or some of the

ART practices may be in collision with their cultural a nd

religious belie fs. Similarly, authors fro m Turkey reported

low acceptance rates of donated gametes by infertile

women if needed for their treatment [17]. On the con-

trary, st udies from Greece revealed that about 50 percent

of the surveyed participant would be prepared to use

donated gametes, though men are more likely than

women to use donated gametes [18]. Although that s tud y

pointed out that confidence in emotional relationship is

negat ivel y a ssoc iated with intention to use donor gamete

[18]. In consonance with this, authors from a develop-

ing country found out that most respondents would ac-

cept do no r gamete for their treat me nt only if it was kept

private for others to consider their offspring as biologica l

[19]. On the issue of donating gamete for other persons

treatment, ab out 42 pe rcent si gnified inte ntion to do nate,

which is similar to rate from a developed country, al-

though donor anonymity and refusal of children’s right

were enhancing factors in that study [20]. On the con-

trary, a Meta analysis revealed that a significant propor-

tion of oocyte donors and women from the general pop-

ulation were prepared to donate their oocyte as iden-

tifiable donor s [21].

Societal institu tion may be slow to cope with the ideas

and practice of ART especially i n Afr ica where the tech-

nology is still relatively ne w. Contentious issues like re-

production without sex, sanctity of family genetic line-

age, involvement of third party and c ommercialization of

gametes and embryos are some of the attitudinal chal-

lenges to contend with in primitive societal settings of

Africa. International machinery to facilitate globalization

of ART services with special attention to man power

trai ni ng, sub si di za t io n o f d r ug s s up ply and establishment

of linkages towards global partne rship as ob tained in the

Millennium Development Goals are enhancing steps to

be taken for the benefit of the less privileged countries.

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