Open Jo urnal of Obstetr ics and Gynecology, 2011, 1, 144-148 OJOG
doi:10.4236 /ojog.2011.13027 Published Online September 2011 ( urnal/ojog/).
Published Online September 2011 in SciRes.
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 : *
Received 20 April 2011; revised 26 April 2011; acce pt e d 5 A ug us t 2011.
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
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
Copyright © 2011 Sc iRes. OJ OG
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.
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.
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-
AGE (years)
Mean and r ange 34.8 (18 46)
Illiterate 28 (18.7)
Primary 34 (22.7)
Secon dary 66 (44.0)
Post sec ondary 11 (14.7)
Unskilled workers 62 (41.3)
Semi skilled workers 66 (44.0 )
Skilled workers 13 (8.7)
Professional 9 (6.0)
Primary 27 (18.0)
Secon dary 123 (82.0)
Family relation 69 (46.0)
Friends 43 (28.7)
Health facility 27 (18.0)
Mass media 6 (4.0)
Others 5 (3.3)
(%) 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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Table 2. Knowledge of some ART practice.
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.
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.
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)
Yes 27 (18.0)
No 5 (3.3)
Do not know 118 (79.7)
Yes 44 (29.3)
No 9 (6.0)
Do not know 97 (64.7)
Yes 11 (7.3)
No 62 (41.3)
Do not know 77 (51.3)
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
Copyright © 2011 Sc iRes. OJ OG
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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