Myth Surrounding Infertility In Nigeria

Women's Health Corner: Talk To Dr G

In the traditional Nigerian society, there are a lot of myth surrounding infertility. In Christianity and traditionally, some believe that it is due to a curse or a sin related to the woman or her ancestral lineage.

Infertility is a reproductive health challenge prevalent in Nigeria. Child bearing continues to be a vital aspect of human life as premium is given to child bearing in contemporary Nigerian society. There is an unspoken belief  that a woman’s place can only be secured and confirmed when she has been able to give birth to a child. Despite our teeming population of 200 million, there is still a high unmet need for infertility in Nigeria.

Any woman with an intact uterus can achieve pregnancy now. Last year, a 62 year old woman conceived with IVF and went on to deliver

Infertility is defined as the inability of a couple to achieve pregnancy after one year of satisfactory unprotected sexual intercourse. I must state very early that it should be seen as a couples challenge and not the fault of any particular individual even when we do classify causal factors as male and female. Infertility has a prevalence of about 15 percent worldwide. It is an age long challenge that has been with us even from biblical times and will continue to be with us. Records abound in the Bible of women who had fertility challenges such as Sarah, Hannah and Elizabeth. Their stories all ended well as they were blessed with children with the exception of David’s wife Michal ( 2 Samuel 6:23 ) who scorned David and did not glorify God and her womb was shut. Early in Genesis 1:28, God gave man the power to be fruitful and to multiply and He has also promised us that there will be no barren in the land ( Exodus 23:26 ).

Poorly treated or untreated sexually transmitted infections is common to both male and female as it can cause tubal blockage in both sexes.

In traditional Nigerian society, there are a lot of myth surrounding infertility. In Christianity and traditionally, some believe that it is due to a curse or a sin related to the woman or her ancestral lineage. Some have adduced inability to conceive to infidelity. However, factors like delayed marriages caused by prolonged educational pursuits and poor socioeconomic status are common these days in Nigeria. The peak of reproductive potential is from 24 to 28 years, therefore our young women should be advised not to marry late.

Poorly treated or untreated sexually transmitted infections is common to both male and female as it can cause tubal blockage in both sexes. Unsafe abortions is still prevalent in Nigeria since it is still clandestinely done. This has resulted in loss of many lives and has halted the reproductive career of many women by blocking the Fallopian tubes and uterine cavity. Other causes of female infertility are ovulatory challenges caused by polycystic ovarian syndrome, premature ovarian failure, and raised prolactin; metabolic conditions such as diabetes mellitus, thyroid diseases, obesity etc. 

Endometriosis is now frequently seen in our clinics and can cause tubal and ovulatory dysfunction. Uterine factors such as fibroids, polyps and adenomyosis are implicated too.
Male infertility is on the increase as most andrology clinics can testify to this fact. Many cases of azospermia and severe oligospermia present to our clinics often. 

It is important for our men to note that life style modification is very important as alcohol, marijuana and smoking are injurious to sperm cells. Radio and chemotherapeutic agents, pesticides, anti-hypertensive medications and petroleum products are also harmful. 

Past history of mumps orchitis, testicular torsion and groin hernia surgery are also implicated. 

It is sad to note that so many couples patronize traditionalist before seeking orthodox care. They believe that traditional Health practitioners have special powers to cure their fertility challenges. Many especially women have either ingested toxic materials or inserted them in their vagina. This has led to untold complications such as gynetresia (closure of vagina from scarring), vessico and recto vagina fistula and kidney failure. 

It is important for our men to note that life style modification is very important as alcohol, marijuana and smoking are injurious to sperm cells.

Restoration of the vagina anatomy is often a very difficult procedure. Our women should therefore be advised against these dangerous practices prevalent in our environment.

The good news is that infertility can be prevented and treated. There are new curing edge technologies that can bring about pregnancy. 

Prevention of infertility include not delaying marriage, prevention and prompt treatment of sexually transmitted infections, avoiding unsafe abortions, use of contraception before marriage, life style modification with respect to smoking and alcohol and recreational drugs use cessation. 

Early presentation is paramount to achieving success in infertility management. I have seen women delay treatment thinking they have all the time on earth and by the time they present late, ovulation would have stopped. Some will tell you that they are trusting in God, not knowing that doctors utilize their God given wisdom.

It is usually good for couples to present to the fertility clinic together with the woman on her 2nd day of menses if possible. At this presentation, history and physical exams is done for them and investigations and treatment commenced. 

We usually perform the seminal fluid analysis for the male, then Hysterosalpingogram (HSG), hormonal profile, trans-vaginal scan, hysteroscopy and laparoscopy when indicated for the woman and screening for sexually transmitted infections.
Different treatment protocols are used to achieve conception. Pelvic infections if any are promptly treated.

 Different forms of treatment range from ovulation monitoring and timed intercourse, ovulation induction and timed intercourse, intrauterine insemination and in-vitro fertilization including intracytoplasmic sperm injection (ICSI).

Any woman with an intact uterus can achieve pregnancy now. Last year, a 62 year old woman conceived with IVF in our Centre and went on to deliver. Mother and baby are doing well. We have had several women in their 40’s and 50’s achieving pregnancy through IVF. People have talked about and are concerned about the moral, ethical and religious issues associated with IVF. Some have said doctors are trying to play God and others have said it means I have no faith in God.

 My usual answer to this is that God has given men wisdom to do this and that you also need faith for it to work. I also tell them that if we are playing God, we will get 100 percent success rate like God but because we are limited as humans, IVF success rate worldwide hovers around 25 to 60 percent.

Other fertility treatment options are use of third party sperm and egg donation program for those without sperms and eggs, surrogacy for those without wombs or with diseased wombs and adoption.

Persistence through Faith in God and persistent in fertility treatment has brought about positive outcomes in infertility treatment in Nigeria. It is doable and numerous testimonies abound that virtually every woman can have her own child.

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Author: Gabriel Igberase. MBBS, MPH, FWACS, FMCOG, FICS.
A Christian OBGYN physician based in Warri, Nigeria. He is a consultant to Shepherd Hospital and Fertility Center, Edjeba Warri and a Chief consultant and associate Professor of Obstetrics and Gynecology, Delta State University Teaching Hospital Oghara and Delta State University, Abraka, Nigeria respectively. His field of interest is in IVF, Gynecological endoscopy, Obstetrics and gynecology Ultrasound and preventive medicine. He his married to her lovely wife Osayi who is a psychiatrist and they are blessed with 4 sons.