ABSTRACT
Introduction: In Nigeria, a major reason for marriage is
procreation and married couples look forward to having children
within a year or two of marriage. The inability
to achieve conception and subsequently have a child among couples may lead to psychological complications. Objective: This
study assessed the psychological impact of infertility and its management on
women receiving treatment at a Fertility Specialist Hospital in a poor resource
setting. Methods: This was a cross-sectional study of 376 consenting
married women who sought and received fertility treatment at a private
Fertility Specialist Hospital, located at Abakaliki, South-East Nigeria between
May 1, 2017 and May 31, 2022. Socio-demographic and Structured questionnaires
were administered to the participants over a 5-year period. Results: The mean age of the
women at presentation was 36.9 (±7.2 SD) years. The majority of the women (227)
presented with secondary infertility accounting for 60.4%, while the rest had
primary infertility (χ2 = 16.18,
P = 0.001). Male-only factor
infertility accounted for 22.9% of all the infertility cases, female-only factor 21.3% while both
(male and female factors co-existing) accounted for 52.7% of all the cases. The
commonest cause of infertility in the study was poor sperm parameters (176) accounting
for 46.8% of cases, tubal factor 19.1% and anovulatory factor 22.3% (χ2 = 214.21, P = 0.001). Three
hundred and thirty four
(88.8%) felt depressed, 266 (70.7%) felt guilty about the past, and 222 (59.0%) had suicidal
tendencies because of the infertility ordeal. Two hundred and fifty one (66.8%) felt inferior,
237 (63.0%) cried often and 174 (46.3%) were socially withdrawn. However, 10.4% of the women felt
satisfied and well. These negative psychological feelings were statistically
significant. Concerning the effect on
marriage, the closeness of couples was reduced significantly in 57.7%, 62.8% had reduced coital intimacy, 79.3% had
frequent quarrel and misunderstanding, 27.9% had threats of divorce while 4.5%
had actually divorced and 11.% separated. However, there was no negative effect
of infertility in 8.8% of couples. Conclusion: Psychological issues
associated with infertility and its management in women include feelings of depression, guilt
feelings, suicidal ideation, weeping episodes, social withdrawal, feelings of
inferiority, reduced libido, and poverty of intimacy with frequent quarrels and misunderstanding. Women appear to bear more of the psychological issues
associated with infertility. Early marriage on the part of the women, preservation
of their reproductive youthful ages, and a better understanding of the concept of infertility
by the couple will not only reduce the prevalence of infertility but will also
reduce the dangerous psychological issues associated with infertility.