ATTITUDE AND WILLINGNESS OF INFERTILE PERSONS TOWARDS THE UPTAKE OF ASSISTED REPRODUCTIVE TECHNOLOGIES IN IBADAN, NIGERIA

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S.O. Akande, I.O. Dipeolu and A.J. Ajuwon

Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.

Abstract

Introduction: In most developing countries, the joy of every married man and woman is to procreate and raise children of their own. However, this desire does not always find fulfilment among some couples because of primary or secondary infertility. The majority who experience this condition live in developing countries where fertility services including Assisted Reproductive Technologies (ARTs) are not always available. This study, therefore, investigated the attitude and willingness of infertile persons to uptake ARTs.

Methods: The study was a descriptive cross-sectional survey; a three-stage multi-stage sampling technique was adopted to select 202 married persons receiving fertility services at a gynaecological clinic in Ibadan, Nigeria. A validated interviewer-administered semi-structured questionnaire was used for data collection. Data were analysed using SPSS with descriptive and inferential statistics with the level of the significant set at <0.05.

Results: Respondents’ age was 34.3 years (SD ± 6.5); 88.6% were female; 55.5% had tertiary education; 54.5% reported a history of primary infertility. The negative attitude towards ARTs was observed among many of the respondents; however, some were willing to use ART services. In vitro fertilization (IVF) was the most preferred method; only 15.0% were optimistic of noncomplications. The cost was the most mentioned barrier to use of ART. Positive association existed between attitude and willingness to use ART. Females are three times more likely than males to have a positive attitude toward the uptake of ART.

Conclusion: Public enlightenment and advocacy are recommended to influence negative attitude towards ARTs.

Keywords: Infertility, Couples, Assisted reproductive technologies, Attitude, Willingness

Introduction

One of the reproductive health concerns of women and a common reason for gynaecological clinic consultations is infertility. In sub-Saharan Africa, the prevalence of infertility is about 30% and of this proportion, male contribution in most countries, including Nigeria, had been estimated to range from 30% to 50%¹. In most communities in Nigeria, having children is a social obligation, parenthood is culturally mandatory, childlessness is socially unacceptable and stigmatized due to a high value placed on children^2,3,4,5,6,7. For example, in South West Nigeria, premium is placed on children for both economic and social reasons⁸. Consequently, couples experiencing infertility may be rejected by the in-laws, causing many infertile couples to seek treatment through different pathways⁸.

As affected couples seek treatment options, they are faced with other serious challenges such as limited treatment facilities and the exorbitant cost of treatment in Nigeria^2,5. Many couples are wary of choosing adoption as a way of resolving infertility because of cultural factors and non-specific provisions for adoption in the Nigeria legal system². Thus, the determination of infertile couples to find a solution to their gynaecological problem has resulted in the patronage of various treatment centres with different interventions. Assisted Reproductive Technologies (ARTs), including In Vitro Fertilisation IVF with fresh or frozen embryos as well as Intra-Cytoplasmic Sperm Injection(ICSI), have come into increasing use in Western nations since the late 1970s⁹, solving more than 50 per cent of infertility cases¹⁰. ART refers to all forms of treatments or procedures that include the in vitro handling of human oocytes and sperm or embryos for the purpose of establishing a pregnancy⁹. Previous studies in Nigeria have focused on prevalence, awareness, perception and attitude towards ARTs^2,11, however, only a few studies exist on the willingness to use ARTs services. The study whose findings are reported in this article was, therefore, conducted to determine the attitudinal disposition and willingness of infertile persons towards the uptake of ARTs in Ibadan, Oyo State, Nigeria.

METHODOLOGY
The Setting
The study was a descriptive cross-sectional survey conducted in Ibadan North, one of the Local Government Areas (LGA) in Ibadan metropolis in South West region, Nigeria. Residents of this LGA are mostly of Yoruba ethnic group, which is the predominant ethnic group in the region. Most residents are in the low and middle socioeconomic status. The study site was Adeoyo Maternity Teaching Hospital, a facility owned by the Oyo State Government and highly utilised by Ibadan residents, especially those in the LGA. The facility also serves as a referral centre for many primary health centres and private clinics within Ibadan and neighbouring towns and communities.

Sampling and Procedures for Data Collection
The study population were married individuals who were receiving care for fertility-related conditions at the gynaecological clinic of the facility. A three-stage sampling technique was used to select 202 consenting individuals among those who visited the clinic for fertility-related challenges during the period of the data collection. After briefing patients about the study, a consecutive number was assigned to every individual who submitted their cards on appointment or checkup on each day of data collection. An average of 10 patients with fertility-related health issues visited the gynaecological clinic on clinic days. The clinic runs from Monday to Thursday, making use of Mondays and Thursdays for registrations and booking of an appointment for new patients, while Tuesdays and Wednesdays were used for consultations with gynaecologists. Therefore, participants who were utilising the clinic for fertility-related problems were recruited from Monday to Thursday. The register in which these patients’ data were recorded during their visit to the clinic served as the sampling frame.