🌸 Men's Health

Female Infertility in Nigeria

Causes, investigation, and treatment options for women struggling to conceive

Female infertility — defined as failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse (or 6 months if the woman is over 35) — affects approximately 1 in 6 couples globally. In Nigeria, infertility carries an enormous social burden: women are disproportionately blamed, face stigma, family pressure, and sometimes marital breakdown. The medical reality is that female factors account for approximately 40% of cases, male factors 40%, and 20% are combined or unexplained. Female infertility in Nigeria has specific patterns — tubal factor infertility (from PID secondary to untreated STIs and unsafe abortions) is particularly prevalent, accounting for up to 40–50% of cases.

Signs and Symptoms

✓ Primary infertility: never achieved a pregnancy

✓ Secondary infertility: previously pregnant but unable to conceive again

✓ Irregular or absent periods (oligo/amenorrhoea) — suggests ovulation problem (PCOS, hypothalamic amenorrhoea, premature ovarian insufficiency)

✓ Painful periods (dysmenorrhoea) — may indicate endometriosis

✓ Heavy, prolonged periods — may indicate fibroids

✓ Pelvic pain, especially with intercourse (dyspareunia) — may indicate endometriosis or PID

✓ Galactorrhoea (milk from breasts when not pregnant) — hyperprolactinaemia affecting ovulation

✓ Excess facial/body hair, weight gain — PCOS

Risk Factors

Pelvic inflammatory disease (PID): most important preventable cause in Nigeria. Untreated gonorrhoea/chlamydia causes tubal scarring — bilateral blockage causes infertility
Unsafe abortion: post-abortion infection leading to tubal damage
Endometriosis: inflammatory condition causing adhesions and tubal damage
Uterine fibroids: submucosal fibroids distort the uterine cavity
PCOS: anovulation (failure to ovulate) — the most common ovulatory disorder
Premature ovarian insufficiency (POI): menopause before age 40
Thyroid disease: hypo- and hyperthyroidism impair ovulation
Obesity or significant underweight: disrupts hypothalamic-pituitary-ovarian axis
Age: fertility declines significantly after 35, rapidly after 40
Smoking, alcohol, extreme exercise

When to Seek Help

After 12 months of trying if under 35Seek assessment for both partners simultaneously — male factor is equally common

After 6 months if over 35Fertility declines rapidly — don't wait the full year

Immediately if known risk factor presentKnown history of PID, STI, PCOS, irregular periods, endometriosis, or prior pelvic surgery — seek investigation sooner

Irregular or absent periodsOvulation assessment needed before even trying — see a gynaecologist

After two or more miscarriagesRecurrent pregnancy loss investigation — different from infertility workup

Tests & Diagnosis

🧪 Day 2–5 FSH, LH, oestradiol

Ovarian reserve and pituitary function. High FSH + low oestradiol = diminished ovarian reserve

🧪 Day 21 progesterone

Confirms ovulation has occurred — progesterone > 30 nmol/L suggests ovulation

🧪 Anti-Müllerian hormone (AMH)

Best test of ovarian reserve — not cycle-day dependent. Low AMH = fewer eggs remaining

🧪 Antral follicle count (AFC)

Transvaginal ultrasound count of small follicles — indicates ovarian reserve

🧪 Pelvic ultrasound

Uterine size, shape, fibroids, ovarian cysts, follicle count, signs of PCOS or endometriosis

🧪 Hysterosalpingogram (HSG)

X-ray dye study — assesses fallopian tube patency (blockage) and uterine cavity shape. The most important test for tubal factor. Done in radiology at all teaching hospitals

🧪 Laparoscopy and dye test

Surgical gold standard for tubal and pelvic pathology — can diagnose and treat endometriosis, adhesions, and fibroids simultaneously

🧪 Thyroid function, prolactin, testosterone

Hormonal causes of anovulation — test when cycles irregular

Treatment Options

Treating underlying cause first

PID: antibiotics. Thyroid disease: thyroxine or carbimazole. Hyperprolactinaemia: cabergoline or bromocriptine. Fibroids: myomectomy if submucosal or large. Endometriosis: laparoscopic excision

Ovulation induction (PCOS, anovulation)

Clomiphene citrate (Clomid) 50–150mg days 2–6 of cycle — induces ovulation in 80% of PCOS cases. Letrozole (increasingly preferred). Gonadotrophins (FSH injections) for clomiphene-resistant cases

Tubal surgery

Laparoscopic adhesiolysis and salpingostomy for distal tubal blockage — success depends on extent of damage. Severe tubal disease: IVF is more effective than surgery

Intrauterine insemination (IUI)

Washed sperm placed directly into uterus around ovulation — success rate 10–20% per cycle. Used for mild male factor, cervical factor, or unexplained infertility

In vitro fertilisation (IVF)

Eggs retrieved, fertilised in laboratory, embryo transferred to uterus. Success rate 30–50% per cycle under 35, falling with age. Available at multiple fertility centres in Lagos, Abuja, Enugu, Kano. Cost: Contact the fertility centre for current pricing

Lifestyle optimisation

Achieve BMI 19–30. Folic acid 400mcg daily. Stop smoking and alcohol. Reduce stress. Moderate exercise (not extreme)

Frequently Asked Questions

Is infertility always the woman's fault?

Absolutely not. Male factor is equally common — affecting approximately 40% of infertile couples. Sperm analysis (semen analysis) should be one of the FIRST tests done in any infertility investigation — it is cheap, non-invasive, and quickly identifies or excludes male factor. Women should never bear the social burden of infertility alone before male testing has been done.

Can traditional medicine help fertility?

Some traditional preparations may have mild effects on hormonal balance. However, many potent traditional preparations contain compounds that are toxic to eggs and sperm. More importantly, using traditional medicine without medical investigation delays diagnosis of treatable causes (tubal blockage, PCOS, fibroids) that respond to specific medical treatment. See a doctor first.

Does having an STI mean I can never have children?

Not necessarily. Early and complete treatment of STIs (gonorrhoea, chlamydia) before they cause significant tubal damage is key. If tubal damage has occurred, the extent determines options — mild damage may be correctable surgically, severe bilateral damage is best treated with IVF. Prompt treatment of any STI is the most important preventive measure.

What is the age limit for IVF in Nigeria?

Most Nigerian fertility centres have an upper age limit of 45–50 for IVF using own eggs. Beyond 40, egg quality declines significantly — IVF success rates with own eggs fall to 10–15% per cycle at age 42 and lower thereafter. Donor egg IVF (using eggs from a younger donor) achieves much higher success rates and is available at some Nigerian centres.