Infertility affects the quality of life of Southwestern Nigerian women and their partners

Abstract

Infertility is defined as a condition manifested through the inability to achieve a successful clinical pregnancy after 12 months of regular unprotected sexual intercourse, among individuals aged 15-49 years (Zegers-Hochschild, 2009, Zegers-Hochschild, et al., 2017). Infertility is a reproductive health problem worldwide, it affects over 10% of the world population, and 30% of the population in Sub-Saharan Africa (Nwobodo, 2011; Tabong, 2013). Infertility has been described as the most important reproductive health concerns of Nigerian women. Estimations from demographic health surveys found an 11% prevalence rate, while clinical based studies suggested rates between 14.5%-30% (Dattijo, 2016; Omoaregba, 2011; Panti, 2014). Infertility can be categorized as primary or secondary. Primary infertility is the inability to achieve conception and to have a successful live birth without ever having a child. On the other hand, secondary infertility is the inability to achieve conception and have a successful live birth when individuals have had a previous biological child (World Health Organization, 2004). In Nigeria, the prevalence of primary infertility is 5% and secondary infertility is 8% (World Health Organization, 2004). The causes of infertility vary and have been linked to environmental issues, occupational related, genetics, and infectious diseases (Siristatidis et al., 2020, Hart, 2016). Both genders 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 (Aduloju, 2015; Diamond, 2017; Mohammad, 2009). Infertility is a condition that attracts stigma in the Nigerian society, where childbearing is considered the hallmark of womanhood, and an inability to bear children makes the society see the woman as incomplete (Dattijo, 2016, Dural et al., 2016). Infertility has been recognized as a potentially serious, costly, and burdensome issue for families (Mohammad, 2009). The discovery that one cannot become pregnant is often unforeseen and results in invasive and demanding medical tests and procedures for both men and women (Diamond, 2017). Furthermore, infertility may put a strain on couples’ relationships, causing feelings of shame, anger, low self-esteem, depression, anxiety, grief, guilt, and suicidal ideation (Omoaregba, 2011; Pasch et al., 2012; Alosaimi, 2017; Kırca and Pasinlioğlu, 2013, Sezgin and Hocaoğlu, 2014). Research shows that women with infertility are prone to intimate partner violence, further aggravating the challenges faced by them (Aduloju, 2015). Most couples who are dealing with the challenges of infertility also battle with helplessness, powerlessness, frustration, and social segregation. Most must develop coping mechanism for the social segregation linked with infertility (Loke, 2012). The majority of individuals seek medical assistance as a treatment for infertility; however, some couples pursue religious practice alongside with the medical treatment, while others visit traditional healers (Fatima, 2016; Gannon, 2004; Meskelu, 2018; Mustafa et al., 2019). Infertility is considered a socially unacceptable condition, leading most infertile couples on a relentless quest for conception. In Nigeria, the social stigma of childlessness still leads to isolation and abandonment (Fehintola, 2017). To the best of our knowledge, no research has been conducted to examine the experiences and the health seeking behavior of infertile couples in Ekiti, and since infertility deeply affects the lives of individuals, we sought to study the experiences of infertile couples in our region. This study used a qualitative research design. Although the target population were couples, most of the participants (13/15) were female as their partners did not accompanied them to the clinic. The sampling criteria included individuals who had been diagnosed with either primary or secondary infertility and who were receiving treatment at the Federal Teaching Hospital Ido-Ekiti, Ekiti state, from January 2019 to April 2019. The participants were selected by convenience based on attendance to the clinic and their willingness to participate in the study. Respondents were interviewed during clinic visits by the second author who is a registered nurse with a Bachelor of Nursing Science degree. She was trained by the first author, an Associate Professor in Nursing on best practices in the conduct of qualitative interviews. The emotional impact of the interview was also envisaged and the training content for the interviewer entailed how to deal with emotional reactions during interviews. Additionally, the hospital counsellor was informed on the possibility of referring clients to them, as a result of the interview if need be. It was agreed that the cost of counselling services will be borne by the researchers. researcher explained the study and obtained informed consent before an oral interview took place. Privacy was assured by conducting the interviews in a private office adjacent to the infertility clinic. Participants were informed that the research was voluntary and that they were free to terminate the interview at any time during the research process. Face-to-face, semi-structured interviews were used to collect data from the participants. The questions were aimed at exploring the experiences and health seeking behaviors of couples attending the fertility clinic. Open-ended questions were designed to ensure flexibility and remain in line with the focus of the study. Participants were asked questions such as “what can you say about your experience with regards to infertility”, ‘how has this experience affected your well-being”, “how has the problem affected your social relationship(work, marriage, families, relationship at work and in-laws)”; “what are the support systems available for you” e.t.c. Participants were also asked questions regarding their health-seeking behaviour e.g “what measures have you taken to solve the problem of infertility”, “what was your first place of resort“ and “what challenges are you currently facing with the treatment you are undergoing” e.t.c. This method was utilized to create a conversation between the researcher and the respondents to explore the phenomena in detail. Each interview lasted between 30-40 minutes. The interviews were voice recorded with the permission of the participants and were transcribed verbatim, except where translations were needed. The interviews were transcribed, carefully read, and double checked by the researchers for accuracy. Qualitative data analysis was employed, identifying themes to analyze the data. Content analysis using open coding according to Tesch’s approach was used (Tesch, 1991; Tesch 2013). The narrative data gathered for each theme was analyzed using open coding which involved breaking down, examining, comparing, conceptualizing, and categorizing data and not merely describing themes (Cresswell, 2009; Polit & Beck, 2008). The purpose aims and benefits of this study were explained to participants, and permission to audio-record the interview, and to take notes, was obtained from them. Informed consent (verbal consent) was obtained from participants before data collection began. Participants were informed that their information would be kept confidential and used for research purposes only. They were also informed that anonymity would be maintained and that they had every right to withdraw their participation after signing the consent without penalty or prejudicial treatment. Quantitative Data

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