1.1 Introduction
Infertility is defined as a disease of the reproductive system characterized by the failure to achieve a clinical pregnancy after twelve months or more of regular unprotected sexual intercourse (World Health Organization, 2023). It is a significant public health issue affecting millions of couples worldwide and is recognized as both a medical and psychosocial condition. The American Society for Reproductive Medicine (ASRM, 2021) further explains infertility as a condition that may result from male factors, female factors, or a combination of both, including ovulatory disorders, tubal blockage, sperm abnormalities, and unexplained reproductive challenges.
The condition is associated with a wide range of contributing factors such as infections of the reproductive tract, hormonal disorders, lifestyle influences, age-related decline in fertility, and genetic abnormalities (Agarwal et al., 2022). As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the aim and objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Infertility is a global reproductive health challenge that continues to attract significant attention due to its medical, psychological, and social implications. According to the World Health Organization (WHO, 2023), infertility is defined as a disease of the reproductive system characterized by the failure to achieve a clinical pregnancy after twelve months or more of regular unprotected sexual intercourse. WHO (2023) reported that infertility affects millions of individuals worldwide, cutting across regions, cultures, and socioeconomic groups, with both male and female factors contributing almost equally to its prevalence. This condition is not only a biomedical issue but also a major life stressor that affects marital stability and social wellbeing.
According to Mascarenhas et al. (2018), global infertility prevalence has remained persistently high over the past decades, with an estimated 8 to 12 percent of couples experiencing difficulty in conceiving. Mascarenhas et al. (2018) asserted that infertility trends vary across regions, with higher burdens observed in developing countries due to limited access to reproductive healthcare, untreated infections, and delayed diagnosis. In sub-Saharan Africa, infertility rates are particularly concerning due to the high prevalence of reproductive tract infections, including sexually transmitted infections, which often lead to tubal damage in women and reduced sperm quality in men.
Agarwal et al. (2022) reported that male factor infertility is often associated with low sperm count, poor sperm motility, hormonal imbalance, genetic abnormalities, and exposure to environmental toxins such as heavy metals, pesticides, and radiation. On the female side, ovulatory disorders, endometriosis, blocked fallopian tubes, and age-related decline in fertility are major contributing factors.
American Society for Reproductive Medicine (ASRM, 2021) stated that joint evaluation of both partners improves diagnosis accuracy and treatment outcomes, yet in many societies, there is a persistent tendency to focus blame on women alone. UNFPA (2022) affirmed that couples experiencing infertility often face discrimination, social isolation, marital conflict, and psychological stress, including depression and anxiety. These challenges are further compounded by financial strain associated with repeated medical consultations and fertility treatments, especially assisted reproductive technologies such as in vitro fertilization (IVF), which are often expensive and inaccessible in low-resource settings.
Dhont et al. (2019) reported that inadequate sexual and reproductive health education contributes to late presentation at fertility clinics, thereby reducing the chances of successful treatment. On the other hand, cultural beliefs and traditional perceptions of infertility often lead couples to seek alternative remedies before accessing modern healthcare services, which may delay proper diagnosis and management. According to WHO (2023), access to fertility care remains unequal globally, with many low- and middle-income countries lacking specialized reproductive health services. This gap in healthcare delivery significantly affects early detection and management of infertility cases, leading to prolonged emotional and physical suffering among couples. In many African settings, including Nigeria, infertility is often stigmatized, and women disproportionately bear the social consequences even when male factors are responsible.
Okonofua et al. (2020) contended that misconceptions about infertility causation, limited access to reproductive endocrinology services, and high cost of treatment continue to hinder effective management. These barriers often result in delayed care-seeking behavior and reliance on unregulated traditional practices. According to studies on reproductive health behavior, awareness of infertility causes and prevention remains low among many couples, particularly in rural and semi-urban communities. This study is set against the backdrop of these persistent challenges, gaps in reproductive health knowledge, and the need to improve understanding of infertility among couples.
1.3 Statement of Problems
Investigation revealed that infertility among couples is a growing reproductive health challenge characterized by the inability to achieve pregnancy after twelve months of regular unprotected sexual intercourse, as defined by the World Health Organization (WHO, 2023). In many settings, including developing regions, infertility is further complicated by limited access to quality reproductive healthcare services, delayed diagnosis, and inadequate awareness of underlying causes.
The condition is often accompanied by psychological distress, marital tension, social stigma, and emotional instability among affected couples, thereby affecting overall family wellbeing (Mascarenhas et al., 2018). Infertility is not only a medical condition but also a social burden that influences relationships, self-esteem, and community perception of marriage and childbearing.
Furthermore, disparities in healthcare access and gender-based attribution of infertility often place unequal blame on women, even when male factors are equally responsible for infertility cases (Agarwal et al., 2022). It is against this backdrop that this study seeks to assess infertility among couples.
1.4 Aim and Objectives of Study
The aim of this study is to assess infertility among couples and evaluate contributing medical, social, and healthcare system factors affecting its diagnosis and management. In achieving this aim, the following specific objectives were laid out as follows:
- To identify the major causes of infertility among couples.
- To examine the level of awareness of infertility causes among couples.
- To assess the availability of infertility diagnostic services in healthcare facilities.
- To determine the role of male and female factors in infertility cases.
- To evaluate challenges faced by couples in accessing infertility treatment services.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What are the major causes of infertility among couples?
- What is the level of awareness of infertility causes among couples?
- How available are infertility diagnostic services in healthcare facilities?
- What roles do male and female factors play in infertility cases?
- What challenges do couples face in accessing infertility treatment services?
1.6 Research Hypotheses
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis 1
- H0: There is no significant relationship between infertility causes and couple infertility cases.
- H1: There is a significant relationship between infertility causes and couple infertility cases.
Hypothesis 2
- H0: There is no significant relationship between awareness level and infertility diagnosis among couples.
- H1: There is a significant relationship between awareness level and infertility diagnosis among couples.
Hypothesis 3
- H0: There is no significant relationship between availability of diagnostic services and infertility management outcomes.
- H1: There is a significant relationship between availability of diagnostic services and infertility management outcomes.
Hypothesis 4
- H0: There is no significant relationship between male and female factors and infertility prevalence.
- H1: There is a significant relationship between male and female factors and infertility prevalence.
Hypothesis 5
- H0: There is no significant relationship between access to treatment services and infertility outcomes among couples.
- H1: There is a significant relationship between access to treatment services and infertility outcomes among couples.
1.7 Significance of Study
It is believed that at the completion of the study, the findings will support healthcare providers in improving infertility diagnosis and treatment services within health facilities. Also, the research will help couples to seek timely medical intervention through improved awareness of infertility factors.
Furthermore, healthcare professionals will benefit from enhanced knowledge for accurate diagnosis and effective treatment of infertility cases. In addition, policymakers will benefit from data that supports development of reproductive health policies and programs.
Lastly, the study will contribute to academic knowledge and future research development in reproductive health studies.
1.8 Scope and Limitations of the Study
The study covers assessment of infertility causes, awareness level, diagnostic availability, and treatment challenges among couples in Lagos State, Nigeria.
The study is limited to selected hospitals due to restricted access to all healthcare facilities within the state, which may affect generalization of findings.
1.9 Definition of Terms
Infertility:
Infertility is the inability of a couple to achieve pregnancy after twelve months or more of regular unprotected sexual intercourse, according to the World Health Organization (WHO, 2023), which reflects a clinical condition affecting reproductive function.
Couples:
Couples refer to two individuals engaged in a marital or sexual relationship who are attempting to conceive a child within a defined reproductive period, as described in reproductive health literature (ASRM, 2021).
Assessment:
Assessment is the systematic process of evaluating and analyzing a health condition using clinical, laboratory, and diagnostic methods to determine its causes and severity (Agarwal et al., 2022).
Reproductive Health:
Reproductive health refers to a state of complete physical, mental, and social well-being in all matters relating to the reproductive system, according to WHO (2023).
Infertility Diagnosis:
Infertility diagnosis is the medical evaluation process used to identify biological, hormonal, or structural causes of infertility in either partner (Mascarenhas et al., 2018).
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