Medical & Clinical Reviews

Keywords

Fertility; Knowledge; Internet; Infertility

Introduction

Infertility is of public health importance in Nigeria and many developing nations because of its high prevalence and especially due to its serious social implications [1]. It is a major source of distress and frustration for men and women and medical practitioners. It causes great worry and sorrow for many couples in Africa especially for the women [2]. The knowledge of infertility and fertility determines, to a large extent, the health seeking behavior of sufferers. There seems to be a lot of ignorance and miss information and superstitious beliefs and myths out there about fertility, infertility, its causes and how to best manage it. A lot of the difficulties in infertility management arise from delay in presentation. Some of this delay is due to lack of knowledge. The fertility IQ 2012 healthcare provider survey revealed that most patients were aware of general fertility information but were less aware of specific details [3]. When men and women become aware of all the issues surrounding fertility and infertility they would be more likely able to properly address this problem. One major way of reaching people these days of the computer age especially the young generation who are the main target audience in fertility information dissemination is via the internet.

Materials and Methods

The study used the Nordica Lagos website www.nordicalagos.org as the location for the study. A simple 20 question multiple choice self-administered questionnaires were posted on the website in May 2012 for visitors to the site to answer and submit.

The study was conducted over a period of one month. The questionnaire had time duration for it to be answered once logged into the site and the questionnaire clicked and once submitted could not be edited. At the end of the study the responses were scored and the results collated and analysed using SPSS version 17.0. If at least 50% of respondents correctly answered a question it was adjudged as sufficient knowledge on that item or issue and vice versa.

Results

A total of 289 persons participated in the online survey. Majority of the respondents lived in the Lagos area but responses came in from virtually all over Nigeria. A few responses came from outside Nigeria.

Population perception of fertility characteristics of a woman is illustrated in Table 1; which 54.7% and 44.3% respondents respectively believed that age at which a woman’s fertility is maximal falls between 20 and 24 years and that fertility begins to wane at 35 years. The Table also shows there was insufficient knowledge on monthly chance of conception as majority (181, 62.6%) of the respondents said 2 months was “time for a 20-year old to get pregnant having regular unprotected intercourse.” The Table also shows that there was insufficient knowledge on what fertile period is as a many of the respondents (143, 49.5%) regarded this to be 4 days before ovulation until day of ovulation.

Table 1: Percentage distribution of public perception of woman’s fertility characteristics.

Public perception of irregular cycle was inappropriate as most (135, 46.7%) respondents felt mere change of dates of menses monthly meant cycles were irregular (Table 2). However, it was observed that the public was quite knowledgeable on the definition of infertility (233, 80.6%), frequency of intercourse per week when trying to conceive (187, 64.7%), strongest risk factor for infertility in women (152, 52.6%) and definition of unexplained infertility (260, 90.0%). It was surprising that a high proportion (120, 41.5%) of public considered staphylococcus as cause of infertility over male (2, 0.7%), female (4, 1.4%) or combined (35, 12.1%) factor. Although gender that experiences infertility most was inappropriately assumed by the public as female (124, 42.9%), unexplained infertility (260, 90.0%) and strongest risk factors for infertility in women (152, 52.6%) were correctly identified as “cause of infertility is not known” and as “advancing age.”

Table 2: Public views on cycle irregularity, infertility and conception.

Distribution of perceptions of the characteristics concerning older women is as described in Table 3. Public opinion was correct on the meaning of menopause, believed by a high proportion (213, 73.7%) of respondents as decline in ovarian function. Most successful option for conception among older women was correctly perceived as IVF using donor eggs by most respondents (163, 56.4%) while few (24, 8.3%) considered it to be Gamete intra-fallopian transfer.

Table 3: Distribution of characteristics of older women.

Where male characteristics in fertility issue was concerned, approximately half (144, 49.8%) of the public took normal sperm count as >20 million/ml though higher proportions (246, 85.1%; 226, 78.2%) saw low sperm count and Seminal Fluid Analysis respectively as the most common sperm abnormality and the basic infertility test done for men in the environment of survey (Table 4).

Table 4: Characteristics of males in fertility and infertility.

Surprisingly a high proportion (189, 65.4%) of the respondents mistakenly believed that certain positions increase the likelihood of conception indicating insufficient knowledge on this issue (Table 5). Nevertheless, there was sufficient knowledge on who to see after a year of tests with no success as a sizeable proportion (174, 60.2%) opted for Fertility Specialist while most (157, 54.3%) decided that a woman aged <35 years should wait for 12 months before seeking fertility assistance.

Table 5: Sex position, time trying to conceive and help-seeking attitude.

Discussion

A good number participated in the study. Lagos is the most populated, cosmopolitan and advanced city in terms of use of internet in Nigeria therefore it was not surprising that majority of the responses came in from the Lagos area. There was sufficient knowledge on such issues as definition of infertility, age at which a woman's fertility is maximal, frequency of intercourse per week when trying to conceive, who to see after a year of tests with no success, basic infertility tests for men, normal sperm counts, most common sperm abnormality, strongest risk factor for infertility in women, how long to wait before seeking help in women less than 35 years of age, what is unexplained infertility, meaning of menopause and what was the most successful option for older women trying to conceive. It was however interesting to note that there was insufficient knowledge on sex positions where a majority felt certain sex positions influenced the chance of conception. This may psychologically affect couples as they may only insist on certain position before they can have intercourse and these may cause friction in their relationship. It was interesting that more than a quarter of the respondents said that a woman’s fertility started to decline at 40 years and beyond. This may explain delay in starting families and delay in presentation which adversely affects chances of conception. About half of the respondents didn’t understand the regularity or otherwise of the menstrual cycle and the fertile period. This may portray how they use it to try to conceive. Many of the respondents felt monthly conception rates were as high as 50-70%. This erroneous believe may be partly responsible for how they view assisted reproduction technology and its success rates and how easy they think it is getting pregnant monthly hence delaying presentation. In Nigeria, many couples have delayed seeking medical help from fertility experts because of the believe made popular by quacks/unqualified drug vendors that staphylococcus was a main cause of infertility and they could treat it with certain medications and then can achieve pregnancy irrespective of whether the woman had blocked fallopian tubes or the man had severe oligospermia or azoospermia. This does wastes time and resources and delays resort to fertility treatment. As is typical in this part of the world accusing fingers usually point to the woman in cases of infertility [1]. In Africa, it is taboo to discuss male infertility. It is something to be concealed at all costs. In Zimbabwe, a traditional practice called “chiramu” involves clandestine bringing-in of the husband’s close relative to impregnate the wife [3]. There is psychological distress and trauma for the woman due to insults from spouse, relatives and neighbors and the husband might take a second wife [2]. The respondents in this study gave more of the blame or problem of infertility to the womenfolk and less to the men.

Conclusion

There is still a need to improve knowledge on fertility and infertility. The online portal is a good source for this. The knowledge from such surveys as this could be used by health care providers to tailor the information they provide to optimize their communication with patients [4].

Study Limitations

This study consists of some limitations related to the cross sectional nature of the study, it looks for associations, not causes and effects. The DHS is a household based survey, and hence excludes significant non-household population groups, like those living on the street or in institutions, for example, prisons, colleges or boarding schools, military barracks, refugee camps, which could have more risk sexual behaviors than the household population. Similarly, as the questionnaire is designed to collect self-reported responses, there could be recall biases and socially-desirable responses and the missing data in the data files may affect the results.

References

1. Araoye MO (2003) Epidemiology of Infertility: Social Problems of the Infertile Couples. West Afr J Med 22: 190-196.
2. Ebere AB (2013) The Problem of Infertility in Africa.The Human Life Review.
3. Matetakuta SN (1998) “Our Own Gift” New Internationalist no 303.
4. https://www.resolve.org/about/in-the-know-fertility-iq-white-paper-2012.pdf