|Year : 2017 | Volume
| Issue : 1 | Page : 14-18
Assisted reproduction technology: Perceptions among infertile couples in Ilorin, Nigeria
Lukman Omotayo Omokanye1, Abdulwaheed Olajide Olatinwo1, Kabir Adekunle Durowade2, Sekinat Titilayo Raji1, Sikiru Abayomi Biliaminu3, Ganiyu Adekunle Salaudeen4
1 Department of Obstetrics and Gynaecology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
2 Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
3 Department of Chemical Pathology and Immunology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
4 Department of Epidemiology and Community Health, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
|Date of Web Publication||17-Jul-2017|
Lukman Omotayo Omokanye
Department of Obstetrics and Gynaecology, College of Health Sciences, University of Ilorin, PMB 1515, Ilorin
Source of Support: None, Conflict of Interest: None
Background: Infertility is a global health problem and a socially destabilizing condition for couples carrying several stigmas and a cause of marital disharmony. Assisted reproduction technologies (ARTs) offers a chance at parenthood to couples, who until recently would have had no hope of having a “biologically related” child. Aims and Objectives: This study aimed to determine the awareness and perception of ART services among infertile couples at a public health facility in Ilorin, Nigeria. Materials and Methods: This is a cross-sectional descriptive study of consecutively consenting infertile couples seen at the ART unit of the Department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Ilorin, between January 1, 2012, and December 31, 2015. Results: The patients aged 22–52 years with a mean age of 36.1 ± 6.6 years and mean duration of infertility of 7.3 ± 5.8 years. Most (60.8%) belonged to middle social class. Of the 559 infertile couples interviewed, 87.3% were aware of ART services. Less than half (48.8%) were aware of surrogacy while majority (85.7%) rejected the use of surrogate mother. Reasons to decline surrogacy were desire to carry one's own child (51.7%) and “do not like the idea” (22.3%). Female partner age, duration of infertility, and religion had a significant influence on acceptance of donor egg (P < 0.05). Conclusion: Despite the high level of awareness of ART, its low utilization remains a gap in the delivery of these services. Government and nongovernmental agencies need to institute interventions to stem the trend.
Keywords: Awareness, gamete donation, Nigeria, surrogacy
|How to cite this article:|
Omokanye LO, Olatinwo AO, Durowade KA, Raji ST, Biliaminu SA, Salaudeen GA. Assisted reproduction technology: Perceptions among infertile couples in Ilorin, Nigeria. Saudi J Health Sci 2017;6:14-8
|How to cite this URL:|
Omokanye LO, Olatinwo AO, Durowade KA, Raji ST, Biliaminu SA, Salaudeen GA. Assisted reproduction technology: Perceptions among infertile couples in Ilorin, Nigeria. Saudi J Health Sci [serial online] 2017 [cited 2018 Mar 24];6:14-8. Available from: http://www.saudijhealthsci.org/text.asp?2017/6/1/14/210809
| Introduction|| |
The birth of Louise Brown on July 25, 1978, was the culmination of decades of scientific research in reproductive medicine. Since then, abundance of breakthrough in both clinical medicine and basic science has all allowed increasing numbers of infertile couples the chance to have a baby. To date, more than 5 million babies have been born worldwide through assisted reproduction technologies (ARTs).
In Nigeria, Oladapo Ashiru pioneered the in vitro fertilization (IVF) program in 1984, and his team successfully delivered the first IVF baby in 1989. This was subsequently followed by reported birth of IVF babies in private- and public-funded facilities within the country. This includes Orhue et al. at University of Benin Teaching Hospital; 2007, Okwelogu et al. at Life Specialist Hospital, Nnewi, 2011 and Omokanye et al. and his team at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.
ART has been reported to relieve more than 50% of infertility. ART can be referred to as all treatments or procedures that include the in vitro handling of human oocytes and sperm or embryo for the purpose of establishing a pregnancy. This includes, but not limited to IVF and transcervical embryo transfer, gamete intrafallopian transfer, zygote intrafallopian transfer, gamete and embryo cryopreservation, oocyte and embryo donation, and gestational surrogacy.
Despite breakthroughs recorded from ART, several barriers militate against its acceptability in our environment. Hence, determining the level of awareness and perceptions on ART practices among infertile couples would be useful in planning public enlightenment programs on advanced infertility treatment. Therefore, this study aims to determine the level of awareness and perceptions of ART treatments among infertile couple at the ART unit of the Department of Obstetrics Gynaecology, UITH, Ilorin, Nigeria.
| Materials and Methods|| |
This is a cross-sectional descriptive study of consecutively consenting infertile couples seen at the ART unit of the Department of Obstetrics and Gynaecology, UITH, Ilorin between January 1, 2012, and December 31, 2015. Interviewer-administered questionnaire which was earlier pretested at gynecology clinic of UITH was used to collect data on biosocial variables, awareness, utilization, and perceptions about ART services. Infertile couples were interviewed by the fertility experts in the clinic, and confidentiality was ensured.
Statistical analysis was done using a commercial statistical package (SPSS/PC version 16.0, SPSS Inc., Chicago, IL, USA). The result was expressed as percentages and mean with standard deviation. P< 0.05 was considered as statistically significant.
| Results|| |
Five hundred and fifty-nine infertile couples had infertility consultation during the study period. The patients aged 22–52 years with a mean age of 36.1 ± 6.6 years. Two hundred and twenty-eight (40.8%) had primary infertility while 331 (59.2%) had secondary infertility. More than a third (36.3%) had female alone factor infertility. Most (60.8%) belong to the middle social class. Their duration of infertility ranges between 1 and 33 years with a mean duration of 7.3 ± 5.8 years [Table 1].
Four hundred and eighty-eight (87.3%) were aware of ART services. Sources of information were from health facility (48.8%), mass media (21.3%), the internet (10%), and family relations (7.2%), respectively. Majority (75%) had friends and/or family relation who had undergone ART procedure. Most (63.3%) were of the opinion that ART is financially accessible. Knowledge on ART practices showed that 56.7% were aware that the procedure could fail, 35.1% knew that it could address male infertility [Table 2].
One hundred and five (18.8%) were aware of gamete donation for ART treatments. More than half (52.6%) preferred the use of own gametes for ART treatments while (47.4%) opted for anonymous donor gametes. Less than half (48.8%) were aware of surrogacy while majority (85.7%) rejected the use of surrogate mother. Reasons to decline surrogacy were desire to carry one own child (51.7%), “do not like the idea” (22.3%), faith that God will provide a baby (16.9%), and “not better than adoption” (9.8%) [Table 3]. Female partner age, duration of infertility, and religion had a significant influence on acceptance of donor egg (P < 0.05) [Table 4].
|Table 4: Relationship between the sociodemographic characteristics of respondents and their preference for source of egg|
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| Discussion|| |
Secondary infertility mostly due to tubal occlusion and male factor infertility accounts for most cases of infertility in Nigeria (30%–40%) each., They are also the most common indication for referrals for ART. With increasing numbers of trained IVF specialists and IVF/ART centers in the country, ART services have become more readily available to Nigerians, but its awareness has been poor. The majority of the patients (87.3%) in our study were aware of ART services. A high level of awareness was also found in northern Nigeria, Iran, Europe, and the United States of America. In contrast, the level of awareness in Lagos (51.8%), Ibadan (58.3%), Osun (48%) and Okija, and Nigeria (37.6%),,, was low. These studies were, however, carried out in general gynecology clinics where there is no facility for ART services, and this may have contributed to the low level of awareness. The high level of awareness in this facility is not surprising as the ART unit mostly serve patients who have been evaluated and/or previously treated for infertility in the general outpatient gynecology clinic as well as in peripheral hospitals. The majority of these patients had been counseled and subsequently referred for ART services. This also explains why almost half of the patients had learned of ART services from health personnel.
The study was carried out in an urban center with 63% of subjects in the middle and high social classes, thus a significant number of patients had heard of ART from mass media and the Internet. Three-quarters of patients had a friend or family member who had undergone ART.
A major challenge to the utilization of ART services in Nigeria is cost. A cycle of IVF costs between (#500,000 and #3,000,000) depending on the facility. Additional costs are incurred for techniques such as intracytoplasmic sperm injection and the use of gamete donors. Nigeria has been classified a lower-middle income country by the World Bank with 46% of her population below the poverty line. Many patients who require infertility treatment and ART services cannot afford it. Worse still, the National Health Insurance Scheme does not cover the investigation and treatment of infertility. The governments of developing countries are more concerned about limiting the high fertility rates than subsidizing infertility care; this discrepancy has been well described in the article by Araoye.
About 63% of patients could afford ART in this study. Our local experience has shown that following counseling and referral for ART in infertile couples, those patients who have the financial capacity tend to present at the clinic whereas the converse is the case for those who cannot afford it. In the study in Northern Nigeria, only 2.7% of subjects could afford ART.
Only 35.1% of patients were aware that ART could address male infertility. This is similar to the findings by Adesiyun et al. and even lower in Okija. This figure is low considering that male infertility is the second commonest cause of infertility in developing countries.,
Despite an average level of awareness of surrogacy among the subjects, only 14% would agree to use it. In the study in Okija, none of the respondents agreed to the use of surrogacy. However, the respondents in Ibadan  and Greece  were better acceptors. The majority of respondents in this study declined surrogacy because of their desire to carry their own child. Other reasons were because they do not like the idea, have faith that God would provide a baby and 9.8% felt it was not better than adoption. These reasons are similar to those found in other Nigerian studies., It also reflects the negative attitude to adoption found in other studies. Religion has a strong influence on acceptance of surrogacy likewise preference for donor eggs as shown in this and other studies.,
There was poor awareness of gamete donation in this study (18.8%). About 53% of couples preferred to use their own sperm and/or egg. This was similar to a study in Greece. Those who accepted donor gametes opted for anonymous donors. This is similar to a study in a developing country, in which couples were willing to accept gamete donation as long as confidentiality was assured and they could pass off the offspring as their own biological children. Again, this reflects the desire in the average African couple to be seen as being able to conceive and to have a genetic relationship with their children. It also explains the negative attitude displayed toward surrogacy and adoption.
Surprisingly, younger women had a greater tendency to prefer donor eggs than older infertile women. The reasons for this finding could be attributed to family/peer pressure in the young since majority of the older women are already divorced and stigmatized. Duration of infertility also had a strong influence on acceptance of gamete donation. Those with infertility of 5–9 years duration were most likely to accept gamete donation. This may be due to the long years of infertility which will make them more willing to accept any suggested option.
| Conclusion|| |
Despite the rising cases of infertility in the society and the high level of awareness of ART services, the abysmal low level of utilization of these services remains a huge gap. One of the options of care in ART services is the use of surrogate mothers. From this study, a great number of couples rejected the choice of surrogacy as the ability to carry one's own child seems more preferred. Duration of infertility and the age of female partner were significantly associated with the acceptance of donor egg. Consequently, there is a need for relevant government agencies and nongovernmental organizations to institute educational interventions to raise the awareness of surrogacy as an option of care available for infertile couples. This will go a long way to reducing the negative assumptions/perceptions of infertile couples toward surrogacy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wang J, Sauer MV.In vitro
fertilization (IVF): A review of 3 decades of clinical innovation and technological advancement. Ther Clin Risk Manag 2006;2:355-64.
Adamson GD, Tabangin M, Macaluso M, De Mouzon J. The numbers of babies born globally after treatment with the assisted reproductive technologies (ART). Fertil Steril 2013;100:S42.
Okwelogu IS, Azuike EC, Ikechebelu JI, Nnebue CK.In vitro
fertilization practice: Awareness and perceptions among women attending fertility clinics in Okija, Anambra State, Nigeria. Afrimedic J 2012;3:5-10.
Orhue AA, Aziken ME, Osemwenkha AP, Ibadin KO, Odoma G.In vitro
fertilization at a public hospital in Nigeria. Int J Gynaecol Obstet 2012;118:56-60.
Omokanye LO, Olatinwo AW, Biliaminu SA, Durowade KA. Successful pregnancy outcome after in vitro
fertilization at a public health facility in Nigeria. J Med Investig Pract 2014;9:157-9.
Cookie ID. The globalization of reproductive technology. In: Kruger TF, van der Spuy Z, Kemper BD, editors. Advances in Fertility Studies and Reproductive Medicine. Cape Town: Juta and Co Ltd.; 2007. p. 234-40.
Olugbenga BA, Adebimpe W, Olanrewaju S, Babatunde O, Oke O. Prevalence of infertility and acceptability of assisted reproductive technology among women attending gynaecology clinics in tertiary institution in southwestern Nigeria. Gynecol Obstet (Sunnyvale) 2014;4:1-7.
Aluko-Arowolo SO, Ayodele SJ. The effects of native culture and religious beliefs on human infertility and assisted reproductive treatment: A focus on the Ijebu people of Nigeria. Afr J Soc Sci 2014;88:88-102.
Cates W, Farley TM, Rowe PJ. Worldwide patterns of infertility: Is Africa different? Lancet 1985;2:596-8.
Giwa-Osagie OF, Ogunyemi D, Emuveyan EE, Akinla OA. Etiologic classification and sociomedical characteristics of infertility in 250 couples. Int J Fertil 1984;29:104-8.
Adesiyun AG, Ameh N, Avidime S, Muazu A. Awareness and perception of assisted reproductive technology practice amongst women with infertility in Northern Nigeria. Open J Obstet Gynecol 2011;1:144-8.
Sohrabuand F, Jafarabadi M. Knowledge and attitudes of infertile couples about assisted reproductive technology. Iran J Reprod Med 2005;3:90-4.
Adashi EY, Cohen J, Hamberger L, Jones HW Jr., de Kretser DM, Lunenfeld B, et al.
Public perception on infertility and its treatment: An international survey. The Bertarelli Foundation Scientific Board. Hum Reprod 2000;15:330-4.
Fabamwo AO, Akinola OI. The understanding and acceptability of assisted reproductive technology (ART) among infertile women in urban Lagos, Nigeria. J Obstet Gynaecol 2013;33:71-4.
Bello FA, Akinajo OR, Olayemi O. In-vitro
fertilization, gamete donation and surrogacy: Perceptions of women attending an infertility clinic in Ibadan, Nigeria. Afr J Reprod Health 2014;18:127-33.
Araoye MO. Epidemiology of infertility: Social problems of the infertile couples. West Afr J Med 2003;22:190-6.
Chliaoutakis JE. A relationship between traditionally motivated patterns and gamete donation and surrogacy in urban areas of Greece. Hum Reprod 2002;17:2187-91.
Oladokun A, Arulogun O, Oladokun R, Adenike Bello F, Morhassan-Bello IO, Bambgoye EA, et al.
Attitude of infertile women to child adoption in Nigeria. Niger J Physiol Sci 2010;25:47-9.
Chliaoutakis JE, Koukouli S, Papadakaki M. Using attitudinal indicators to explain the public's intention to have recourse to gamete donation and surrogacy. Hum Reprod 2002;17:2995-3002.
Jegede AS, Fayemiwo AS. Cultural and ethical challenges of assisted reproductive technologies in the management of infertility among the Yoruba of Southwestern Nigeria. Afr J Reprod Health 2010;14:115-27.
Annas GJ. The shadow lands-secrets, lies and assisted reproduction. N Engl J Med 1998;339:935-9.
[Table 1], [Table 2], [Table 3], [Table 4]