Care Pathways for Infertility in Cameroon: Between Traditional Practices and Medically Assisted Reproduction ()
1. Introduction
In Cameroon, infertility is a frequent reason for gynecological consultation, with a predominance of secondary forms often linked to sexually transmitted infections (STIs), unsafe abortions, and surgical complications [1] [2]. The absence of children is perceived as a major threat to the social and marital stability of women, who often face stigma, marginalization, and even violence [3]. In response to this suffering, infertile women undertake complex therapeutic pathways, oscillating between conventional medicine and alternative practices. These trajectories reflect not only economic and cultural constraints but also the desperate quest for motherhood in a context where fertility remains a cornerstone of social recognition. The present study aimed to describe and analyze the therapeutic pathways of infertile women in Douala, highlighting the coexistence and sometimes complementarity between traditional practices and biomedical approaches.
2. Methods
2.1. Study Design and Setting
We conducted a cross-sectional analytic study over a seven-month period, from January to July 2025, in four health facilities in the city of Douala (Cameroon). These facilities included public and private hospitals with gynecology-obstetrics services and specialized infertility consultations.
2.2. Study Population
The study included women of reproductive age, between 25 and 55 years old, consulting for primary or secondary infertility.
2.3. Inclusion Criteria
1) Any woman diagnosed as infertile by a gynecologist.
2) Any woman aged 25 years or older.
3) Any woman who provided written informed consent.
2.4. Exclusion Criteria
1) Women with a severe chronic condition likely to alter health-seeking behavior (diabetes, cancer, renal failure).
2) Refusal to participate.
3) Incomplete records.
2.5. Sampling and Sample Size
We used exhaustive sampling, including all women meeting the inclusion criteria during the study period. The final sample size was 173 infertile women.
2.6. Variables Studied
Data collected included:
1) Sociodemographic characteristics: age, marital status, educational level, income.
2) Clinical characteristics: type of infertility (primary or secondary), gynecological history of STIs, induced abortion, surgery.
3) Therapeutic pathways: self-medication, use of herbal medicine (medicinal plants, traditional healers), recourse to assisted reproductive technologies (ovarian stimulation, pelvic surgery, in vitro fertilization).
2.7. Data Collection Tool
A structured, pretested questionnaire was administered face-to-face by trained interviewers. Women were asked to specify all therapeutic approaches undertaken since the onset of infertility, as well as the reasons guiding their choices (accessibility, cost, family influence, perceived effectiveness).
2.8. Statistical Analysis
Data were entered and analyzed using SPSS version 26.0. Quantitative variables were presented as means ± standard deviation. Qualitative variables were expressed as frequencies and percentages. Associations between therapeutic choices and women’s characteristics were explored using the Chi-square test. A multivariate logistic regression model was used to identify independent determinants of recourse to traditional versus biomedical practices. Statistical significance was set at p < 0.05.
2.9. Ethical Considerations
Ethical clearance was obtained from the Institutional Ethics Committee of the University of Douala. Anonymity and confidentiality of data were guaranteed. All participants provided written informed consent.
3. Results
3.1. General Characteristics of the Study Population
A total of 173 infertile women were included in the study. The mean age was 37.2 ± 6.1 years (range 25 - 55 years), the majority age group was [35 - 40] years. More than half were living in a common-law union (55.5%), 30% were single, and 14.5% were formally married. Higher education accounted for 44.7% of participants, while 46.2% reported monthly income below 100,000 FCFA. Secondary infertility predominated (76.9%). Histories of STIs and abortions were frequent, reported in 53.7% and 52.6% of women, respectively (Table 1).
Table 1. Sociodemographic and clinical characteristics of participants.
Variables |
N |
% |
Mean age (± SD) |
37.2 ± 6.1 |
- |
Single |
52 |
30.0 |
Common-law union |
96 |
55.5 |
Married |
25 |
14.5 |
Higher education |
77 |
44.7 |
Income < 100,000 FCFA |
80 |
46.2 |
Secondary infertility |
133 |
76.9 |
History of STIs |
93 |
53.7 |
History of abortion |
91 |
52.6 |
3.2. Therapeutic Pathways
Therapeutic practices were multiple and often combined:
1) Self-medication: 110 women (63.6%) practiced self-medication, most often with antibiotics or antifungals purchased without prescription.
2) Herbal medicine: 118 women (68.2%) used medicinal plants or consulted traditional healers. Reasons given included accessibility (72%), lower cost (65%), and family pressure (30%).
3) Medically Assisted Reproduction: 90 women (51.8%) underwent ovarian stimulation, 56 (32.4%) pelvic surgery, and 15 (8.7%) attempted in vitro fertilization (IVF) (Table 2).
Table 2. Therapeutic pathways of infertile women.
Type of recourse |
N |
% |
Self-medication |
110 |
63.6 |
Herbal medicine |
118 |
68.2 |
Ovarian stimulation |
90 |
51.8 |
Pelvic surgery |
56 |
32.4 |
In vitro fertilization (IVF) |
15 |
8.7 |
3.3. Factors Associated with Therapeutic Pathways
Multivariate analysis showed that:
1) Low income was associated with increased recourse to herbal medicine (OR = 2.3 (1.2 - 4.4); p = 0.01).
2) Higher education favored access to MAR (OR = 1.8 (1.1 - 3.1); p = 0.03).
3) History of STIs significantly increased the probability of resorting to several successive types of care (OR = 2.6 (1.4 - 4.7); p = 0.004) (Table 3).
Table 3. Determinants of therapeutic choices (multivariate logistic regression).
Determinants |
OR (95% CI) |
p-value |
Income < 100,000 FCFA → herbal medicine |
2.3 (1.2 - 4.4) |
0.01 |
Higher education → MAR |
1.8 (1.1 - 3.1) |
0.03 |
History of STIs → combined pathways |
2.6 (1.4 - 4.7) |
0.004 |
3.4. Recourse to Medically Assisted Reproduction (MAR)
Key points from patient interviews and medical records:
1) Ovarian stimulation was the most common recourse, as it is less expensive and more available.
2) Pelvic surgery was indicated in cases of fibroids or sequelae of STIs.
3) Intrauterine insemination (IUI) and especially IVF remained rare, limited by cost and the scarcity of fertility centers in Cameroon.
4) A minority (−12%) followed combined pathways, illustrating the persistent quest for motherhood despite therapeutic failures (Table 4).
Table 4. Details on medically assisted reproduction (MAR) among 173 infertile women.
Type of MAR |
N |
% |
Main remarks |
Ovarian stimulation |
90 |
51.8 |
Most accessible first-line MAR, performed in both public and private hospitals. |
Pelvic surgery (myomectomy,
laparoscopy, hysteroscopy) |
56 |
32.4 |
Mainly indicated for fibroids, adhesions, uterine anomalies. |
Intrauterine insemination (IUI) |
12 |
6.9 |
Rarely practiced, limited by availability of specialized
facilities. |
In vitro fertilization (IVF) |
15 |
8.7 |
Rare due to high cost (>1,500,000 FCFA per cycle) and few accredited centers. |
Combined MAR (≥2 techniques) |
20 |
11.6 |
Some women underwent ovarian stimulation followed by surgery and/or IVF. |
4. Discussion
This study highlights the diversity and complexity of therapeutic pathways undertaken by infertile women in Douala. The findings reveal a high prevalence of self-medication most often with antibiotics or antifungals purchased without prescription and herbal medicine use, alongside a still limited but increasing recourse to Medically Assisted Reproduction.
4.1. Self-Medication and Herbal Medicine: First Steps in the
Pathway
More than half of the participants reported self-medication (63,6%), and 68,2% resorted to herbal medicine. This finding is consistent with studies in Nigeria and Ghana [4] [5], where traditional treatments and over-the-counter medications often constitute the first response to infertility. These practices are driven by accessibility, lower cost, and strong family or community influence. However, they expose women to risks of delayed diagnosis, inappropriate drug use, and sometimes worsening of the initial pathology.
4.2. Recourse to Medically Assisted Reproduction
Nearly half of the women in our study had recourse to some form of MAR, mainly ovarian stimulation and pelvic surgery. In vitro fertilization (IVF), although available in Cameroon, remained marginal (8.7% in our sample) due to high costs and the limited number of specialized centers. This trend is similar to observations in other sub-Saharan African countries, where access to reproductive technologies remains restricted [6] [7]. Nevertheless, the existence of these practices illustrates a gradual transition toward modern biomedical management.
4.3. Determinants of Therapeutic Choices
Our results show that low income increased the likelihood of using herbal medicine, while higher education favored access to MAR. In addition, a history of STIs increased the probability of following combined therapeutic pathways. These associations emphasize the role of socioeconomic and cultural determinants in care-seeking behavior, consistent with the findings of Dyer and Patel in South Africa [3] and Chimbatata in Malawi [8].
4.4. Toward an Integrated Approach to Care
The coexistence of traditional and biomedical practices reflects an adaptive strategy among patients facing financial, cultural, and structural constraints. In the Cameroonian context, several traditional approaches could be integrated into modern infertility care pathways to improve accessibility, cultural acceptability, and overall patient well-being. These include:
1. The use of validated medicinal plants:
Ethnobotanical studies in Cameroon have identified several medicinal plants used traditionally to treat female infertility. For instance, Mammea africana, Cissus quadrangularis, and Scleria striatinux are widely cited by traditional healers for their fertility-enhancing properties [9] [10]. These plants could be subject to further pharmacological research and possibly integrated into complementary treatment protocols under medical supervision.
2. Psychosocial and community-based support:
Traditional healers often provide not only physical remedies but also emotional and spiritual support, which can be critical in infertility care. This dimension is frequently lacking in biomedical settings. Integrating culturally grounded psychosocial support, in collaboration with trained community healers, can enhance patient adherence and emotional resilience [11].
3. Policy-level support:
The recent legal framework adopted by the National Assembly of Cameroon (2022) to regulate medically assisted reproduction opens opportunities for structured integration of certain traditional approaches, especially within community-based care settings [12].
Although the WHO Global Traditional Medicine Strategy 2025-2034 does not specifically address infertility, its strategic orientations offer a solid framework for the integration of traditional practices into reproductive health care. In particular, the focus on evidence generation, regulated oversight, system-level integration, and inclusive, community-based policies provides relevant avenues for legitimizing and structuring complementary approaches to infertility management in Cameroon [13].
4.5. Strengths and Limitations of the Study
This study presents several strengths: a multicenter sample, a systematic exploration of therapeutic pathways, and a multivariate analysis of determinants. However, some limitations must be acknowledged: the cross-sectional design does not allow causal inference, and self-reports on herbal medicine use may have been under- or overestimated due to social desirability bias.
5. Conclusions
This study highlights the complexity of therapeutic pathways followed by infertile women in Douala. Most patients resorted initially to self-medication and herbal medicine, while access to modern reproductive technologies remained limited, particularly for IVF. Socioeconomic, educational, and clinical determinants played a major role in guiding therapeutic choices. These results underscore the need to promote an integrated approach to infertility management in Cameroon, combining:
1) prevention of sexually transmitted infections and unsafe abortions,
2) information and awareness for couples regarding available therapeutic options,
3) regulation and supervision of traditional practices,
4) the implementation of health policies aimed at improving financial and geographical access to reproductive care.
6. Future Perspectives
Future perspectives include involving men in the analysis of therapeutic pathways and exploring the psychological impact of treatment choices. The progressive integration of traditional and modern medicine, within a secure and scientifically validated framework, could provide more adapted and culturally acceptable solutions for infertile couples. Ultimately, the fight against infertility in Cameroon cannot be limited to biomedical advances alone but must also address the sociocultural and economic realities shaping care-seeking behaviors.