Making decisions requires a high level of awareness. To be well informed about a fact, one must be appropriately aware. Women attending an infertility clinic in a Nigerian Tertiary Health Institution were asked about their awareness, perceived efficacy, and use of Assisted Reproductive Technologies (ARTs). ARTs had been heard about by 90.7% of the women, while ART services were known by 57.9%. Health personnel were the most common source of information (55.7%). The center though a Tertiary health institution was not long known to treat infertility via ART services. Previously, women with infertility problem who were enlightened travelled as far as Abuja, Port Harcourt just to obtain the services, ART services even though introduced anew in this center are yet to gain popularity as seen in older practicing establishments, couples who today visit this center are yet to come to terms with the services, most of them are yet not regular with the appoints leading to deficiencies in in-depth knowledge. Furthermore, knowing full well that this is a unique field of expertise that necessitates specialized training, health personnel's insufficiency in imparting knowledge to consumers may be insufficient. Despite this, the proportion of awareness observed in this study was also found in a similar study in a state in Nigeria [28] and in Pakistan in which the majority of the study participants showed limited awareness about infertility management, as well as a high level of disbelief and suspicion about ART procedures [29]. In the current study, 85.6% of participants were aware of various ART treatments, with in-vitro fertilization being the most widely recognized option (IVF). In contrast to other techniques of assisted reproduction, IVF involves manually combining an egg with a sperm sample and then transferring it back into the female uterus. In comparison to other methods, it has been considered as the most adaptable and successful [30]. Around 5.4 million kids were born using IVF [31] in 1978 around the world. Similarly, in Benin City Nigeria in 2011, 70.1% and 71.9% of the infertile parents described the offspring from IVF as normal and acceptable [26]. Likewise, a study titled “Experience with a comprehensive University hospital-based infertility program in Nigeria” [32] described IVF as the most acceptable choice of ARTs, widely used in developed countries of the world [33, 34]. The interest to use IVF procedure as noted in this present study is not peculiar with Nigeria probably because of the less complexity, the method attracts more acceptances. In the midst of other methods, surrogacy was the second major chosen method thereby disproving the cultural bias or mindset of our people that a woman, who wants to be a "mother", should deliver her baby through the natural means. Surrogacy as one of the ART procedures lawfully permits a woman to carry pregnancy for another who will become the parent of the child. By implication the result obtained in this study showed that cultural bias of one harboring pregnancy for another did not in any form discourage the choice of accessing this method in this study as one would had expected among Africans [35].
Majority 89.7% knew the procedure could not address male infertility and 80.4% were aware it could fail in establishing pregnancy. This is surprising because male factor infertility contributes either as a single factor or in combination of female causes to bring about more than 40% cases of infertility witnessed wide world [26, 36]. Hence, despite the level of awareness about ART services, awareness of ARTs efficacy was found very low. The high number underrating the efficacy of the procedure illustrates the direct influence that lack of sufficient knowledge and misconceptions can have on one’s attitudes [18]. This research should help healthcare professionals to educate the public about ART, so that misunderstandings do not hinder public acceptance of these treatments.
The utilization of ART services was still found to be profoundly low as observed in a study of 3years ago [33]. 25.2% (n=27) of the women reported to have used IVF once, 14.8% (n=4) twice though majority 71.0% expressed interest to make use of the technology in future if given the opportunity based on the uncompromised benefits. This is similar to a report of study in IIorin [ 37]and Benin city [9] in Nigeria where majority of the respondent’s indicated intention to advice and share information about the existence of ARTs with friends, relatives and neighbours. Similarly reports obtained in Anambra State [22], Sokoto [38], Northern Nigeria [33], Ibadan [39] and more still in IIorin [18] showed low interest to use of ART services. In Northern part of Nigeria only handful, 7.6% of clients were willing to embrace ART services [42]same alsoin Ibadan[45] and Ilorin in Nigeria study [18]. Likewise in a study in Iran [15] and Pakistan [29] IVF remains an unfamiliar and an unacceptable option. That notwithstanding ART services currently are generating much interest in many parts of the world with low perception still existing in developing countries were education, poverty and cultural background may have and continued to play great role [9].
High cost of obtaining ART services 76.6% among others was identified as the major barrier to utilization. It is a fact in Nigeria, that government ARTs established centers are only two of the over fourteen In-vitro fertilization and Embryo transfer centers found in the country hence privately-owned ART establishments charge exorbitantly. With the majority of Nigerians living in abysmal poverty and the minimum income for only civil officials set at ₦18,000, which is even unpaid in certain areas, acquiring ART services remains a distant dream for the majority of infertile couples.
Depending on the service facility, an IVF cycle might cost anywhere between ₦500,000 and ₦3,500,000 [40]. According to all indications, many couples struggling with infertility would have wanted for this option but were unable to do so due to financial constraints. No wonder many despite the prohibitive cost of obtaining the services showed positive attitude and willingness to go for the procedure and also promised to recommend the same to others. But dismally in Northern Nigeria [34] very few couples 7.6% showed willingness to opt for ARTs. Their resilience could be hinged to their culture. In Northern part of the country polygamy is the practice of which a man is entitled to as many as possible number of wives and the woman could decide to abandon the initial married thus the issue of not having a child may not have any stronghold as seen in the Eastern.