Statistics show that about 10 to 30 per cent of Nigerian couples struggle with infertility. Gom Mirian examines how this inflicts emotional, physical and financial hardship on marriages, especially on women.
Mrs. Rufina Jacob, a 49-year-old veterinary doctor, who did not want her photograph attached to this story, has been happily married for 14 years to a lovely and supportive husband. However, the absence of a child in the marriage has been interrupting the peaceful coexistence in her home, not because she lacks the love of her husband, but due to interference by relatives who make it a duty to torment her over her inability to have children of her own.
Impact of infertility on mental health of patients
Having given up hope, she told African Health Report (AHR) that she is only alive because God is comforting her over her situation.
Infertility is associated with a lot of negative psychosocial and other consequences such as stigma, deprivation, neglect, violence, marital problems and mental health issues. Though it is medically expected that a healthy female of reproducing age becomes pregnant within three months of having unprotected sex, infertility affects about 17.5 per cent of the adult population, which translates to 1 out of every 6 people globally, according to a World Health Organisation (WHO) report.
Despite the fact that infertility affects couples of childbearing age all around the world, it is more stigmatised in women in Africa, than in other continents. A woman is considered medically infertile when she is unable to conceive within 12 to 24 months of unprotected and regular sexual activity, or to carry a pregnancy to term.
In Nigeria, statistics have shown that about 10 to 30 per cent of couples struggle with infertility, which results to emotional, physical, and financial hardship for the couples, particularly the woman. This, most times, leads to broken marriages.
Infertility can be categorised as primary or secondary. Primary infertility is the inability to achieve conception and to have a successful live birth without ever having a child, while secondary infertility is the inability to achieve conception and have a successful live birth when individuals have had a previous biological child, according to WHO.
In Nigeria, citing WHO statistics, the prevalence of primary infertility is 5% and secondary infertility is 8%. The causes of infertility vary and have been linked to environmental issues, occupational related, genetics, and infectious diseases. Both male and female are affected in 40% of cases, but the most common reasons for reproductive problems are conditions such as ovulatory disorders (25%), fallopian tubal damage (20%), and uterine or peritoneal abnormalities (10%). However, in 30 % of cases, causes are unknown.
Most couples faced with infertility struggle with feelings of helplessness, powerlessness, frustration and social segregation. All these are feelings Mrs. Rufina Jacob identified with and shared with our reporter during an interview for this article.
She said: “I refrained from having sexual relations to avoid an abortion so that I might have a family as soon as I got married, but here I am, having been infertile for over 14 years.
“My husband was understanding, being aware of the lifestyle I lead, but when pressure from his family to remarry increased, he changed. Despite doing everything they asked and taking on all household responsibilities, I was detested the more. I was also prohibited from going to church, among other things, and I became a shadow of who I once was.
“After being attacked and dragged on the ground from my church to the house where I wanted to seek solace because of the rejection on one fateful Sunday, by my husband’s elder brother and his mother, I decided to go back to my house. My husband and I are presently residing in a leased apartment to escape his mother’s tyranny,” she narrated, her eyes dim with sorrow.
…finances and social life affected too
The impact of infertility also affects the finances of the couples, with many unable to pay for the expensive treatment or remedial procedures recommended by doctors from their private purses.
“My husband and I just had a fertility test, had treatment, and are currently awaiting an implant, however because of our little incomes, we are unable to cover the whole cost. Instead, we’ve made a partial payment and will finish it whenever the money is available,” Mrs Jacob added.
She is among the women who are lucky to have understanding and supportive partners. Infertility may put a strain on couples’ relationships, causing feelings of shame, anger, low self-esteem, depression, anxiety, grief and guilt. In some cases, there may be suicidal inclinations.
Research also shows that women with infertility are prone to intimate partner violence, maltreatment or abandonment, further aggravating their condition.
For Juliana Bulus, another woman infertility patient who declined to a request to attach her photograph, her condition has led to her losing all she worked so hard to get, including her marriage.
The 48-year-old businesswoman told AHR: “I funded my then fiance’s higher education despite agitations from my father not to marry him, who he characterised as an alcoholic and a chain smoker.
“When there were no signs of pregnancy after six years of our marriage, I got concerned and advised him that we should have a fertility test. He refused, stating that he was not complaining. I had no idea he had married a second woman. By the time he moved into his new home with his wife, he had told his security to arrest me whenever I go close to the house.
“I lost everything, including my marriage, and had to start again, which was difficult for me and my family at the time. However, thanks to God, I am now happily remarried and, as my doctor verified, three months pregnant,” she said smiling.
Men contribute 30-40 percent to infertility in marriages – Experts
Dr Kemi Ailoje, a fertility expert, in an interview with AHR, stated that it is erroneous to assume that the majority of infertility issues in marriages are brought on by the woman, as infertility could have several causes that could be linked to both male and female, and in some cases, a combination of issues affecting both couples may be the root of the issue.
According to her, male factors are to blame for infertility in couples 30 to 40 per cent of the time, followed by female factors in another 30 to 40 per cent of instances, and male and female factors mixed or unidentified causes in the remaining cases.
“It is vital to remember that these percentages may change based on other factors. Ovulation disorders, such as polycystic ovary syndrome (PCOS) or hormonal imbalances, blocked fallopian tubes, uterine abnormalities, endometriosis, and age-related issues are common reasons for female infertility.
“Male infertility can be caused by low sperm counts, abnormal sperm motility or morphology, hormonal imbalances, inherited factors, or certain medical conditions. It’s crucial to avoid assigning blame or assuming that one partner is the lone cause of infertility. It is a well-known reality that infertility is a complex issue, thus couples must discuss their reproductive health concerns with an infertility specialist. They can help uncover the underlying issues and provide proper advice and therapeutic options based on the particular circumstances of each marriage.”
Another expert, Dr. Ejike Oji, a reproductive endocrinologist, also said in a chat with AHR, that while it is commonly accepted that roughly 40 per cent of cases of infertility are due to male factors, it is important to keep in mind that the precise prevalence might vary, depending on the research population and the criteria used to define infertility.
He said male infertility may be caused by a variety of factors, including poor sperm production or function, hormonal imbalances, genetic abnormalities, anatomical issues, infections, and lifestyle choices including smoking or binge drinking, adding that sometimes, the cause of male infertility goes unidentified.
“In certain cases, it may even be infertility problems for both partners. As a result, it is critical for couples experiencing infertility issues to meet with reproductive Endocrinologists/Infertility specialists to acquire a full evaluation and tailored diagnosis.”
How infertility can be addressed in Nigeria
According to Dr Ailoje, Nigeria has advanced in the field of Assisted Reproductive Technology (ART) treatments and access to basic treatment in Nigeria but challenges in geographic disparities, treatment costs, specialised skills and a lack of modern equipment with its cutting-edge technologies available in many other countries still abound.
She explained: “Private fertility clinics and facilities, particularly in big cities like Lagos and Abuja, offer a variety of ART procedures, including in vitro fertilisation (IVF), intrauterine insemination (IUI), and fertility drugs. These clinics are equipped with trained medical personnel and modern facilities to conduct basic ART services.
“Access to basic ART treatments, on the other hand, may be limited in rural areas and less developed portions of the country. Factors such as a lack of infrastructure, poor healthcare facilities, and a shortage of trained fertility specialists can all contribute to the gap in access to ART across the country.
“Another issue is the high expense of ART therapies. Basic ART procedures can be costly, and not everyone or every couple can afford them. As a result, many Nigerians may find access to ART therapies prohibitively expensive.
“The Nigerian government and non-governmental organisations should collaborate to improve access to ART services by offering palliative services like the development of specialised fertility centres, training programmes for medical professionals, and public awareness campaigns to combat the stigma attached to infertility.
“Several policy measures, including insurance regulations must be put in place to ensure that infertility is fully covered by health insurance policies, including fertility treatments, diagnostic exams, and fertility preservation. This would lower the price of out-of-pocket therapies and provide patients with affordable access to life-saving medicines.
”Also, increase public funding for infertility treatment, particularly for those with little income. To provide financial assistance for fertility treatments like in vitro fertilisation (IVF) or other assisted reproductive technologies, it may be necessary to establish government-funded grants or programmes.”
