Knowledge, Attitude and Perception of in Vitro-Fertilization Among Married Men in Abia State, Nigeria

INTRODUCTION

Infertility is a growing global public health concern that affects couples’ health, psychological well-being and social stability [1]. Worldwide, it is estimated that about 10 to 15 percent of couples experience infertility, with substantial social and emotional consequences for individuals and families, particularly in low- and middle-income countries such as Nigeria, where cultural expectations of childbearing are strong [2]. Infertility not only undermines personal identity and marital relationships but also carries stigmas that can influence community perceptions and treatment-seeking behaviors [3].

In Nigeria, infertility is recognised as a significant reproductive health issue with deep cultural and social implications [4]. It impacts marital harmony, economic stability and personal well-being. Despite increased access to reproductive technologies globally, awareness and utilization of assisted reproductive technologies, such as in vitro fertilization (IVF), remain limited in many parts of the country. IVF is a form of assisted reproductive technology in which eggs and sperm are combined outside the body, and the resulting embryo is placed in the uterus to achieve pregnancy. It offers hope to couples facing infertility, especially when conventional treatments fail. However, in resource-limited settings, access to IVF services is often constrained by high costs, limited specialised facilities, and social misconceptions about the procedure itself [5].

Studies within parts of Nigeria show a wide variation in knowledge and acceptance of IVF and other assisted reproductive technologies. Research conducted among the general Nigerian public revealed that a majority of people hold positive views toward assisted reproductive technologies, but awareness and willingness to use them can differ by gender, education level and cultural context [5]. Evidence from a cross-sectional study in Port Harcourt indicated that awareness of IVF among women attending fertility clinics was relatively high and perceptions were moderately positive, but factors such as recommendations from health professionals, cultural beliefs and financial barriers strongly influenced acceptance [6]. Additional research in Anambra State found that married couples have mixed perceptions of infertility and IVF, with many associating infertilities with destiny or supernatural causes, and identifying cost and misconceptions as barriers to the uptake of IVF treatments [7].

Despite these insights, there remains a notable gap in published research that focuses specifically on married men’s knowledge, attitudes and perceptions of IVF in Nigeria. Most available studies either concentrate on women, couples collectively, or specific sub-populations such as medical students. For instance, research among final-year medical students in South-West Nigeria showed high basic awareness of IVF, yet underscored concerns about its cost and social implications, including beliefs about infertility and gendered blame patterns [8]. Additionally, studies addressing perceptions of male infertility have documented persistent misconceptions among men about causes and management of infertility, highlighting a need for improved education and community engagement regarding male reproductive health [9].

Men’s roles in reproductive decision-making are particularly important in the Nigerian context. Sociocultural norms often empower husbands as primary decision-makers in family health matters, including fertility treatments and whether couples seek assisted reproductive interventions [10]. Yet men may lack accurate information on infertility and viable treatment options such as IVF, or may hold attitudes shaped by cultural stigma, religious beliefs or economic concerns. Without specific research on male perspectives in settings like Abia State, policymakers and health practitioners risk overlooking critical aspects that influence access to and utilization of IVF services.

The current study seeks to fill this gap by focusing exclusively on married men in Abia State, a region of Southeastern Nigeria where cultural expectations of fatherhood and family continuity remain strong. By examining men’s knowledge about the IVF process, their attitudes toward its use, and their underlying perceptions shaped by social, cultural and economic factors, this research will provide critical insights that can inform targeted educational interventions, health communication strategies, and policy planning. Enhanced understanding of men’s reproductive health perspectives may contribute to improved couple engagement with fertility services and support broader reproductive health goals in the region.

MATERIALS AND METHODS

Study Design

This study was a descriptive cross-sectional survey designed to assess the level of knowledge, attitudes, and perceptions regarding in-vitro fertilization (IVF) among married men residing in Aba, Abia State, Nigeria. The descriptive design was chosen because it allows for the measurement of the prevalence and distribution of variables, and it is appropriate for collecting information on knowledge, attitudes, and perceptions at a single point in time.

Study Area

The research was conducted in Aba, a major commercial city in Abia State, located in Southeast Nigeria. Aba has a large and diverse population drawn from multiple socio-economic backgrounds. Married men from the various residential and commercial districts of Aba were recruited for this study.

Study Population

The study population consisted of married men aged 18 years and above who had been residents of Aba for at least six months before the study. Men living in polygamous or monogamous unions were included, while unmarried men, divorced men, widowers, and those unwilling to participate were excluded.

Sample Size Determination

The sample size was determined using Cochran’s formula for estimating population proportions, as outlined by Akwuruoha et al. [11]:

n =           

The formula components are defined as follows:

• n represents the minimum required sample size.
• Z is set at 1.96, corresponding to a 95% confidence level.
• P denotes the estimated proportion of married men with adequate knowledge of IVF (assumed to be 50% for maximum sample size).
• e signifies the allowable margin of error, fixed at 5% (0.05).

q = 1 – p

P = 50% = 0.5

q = 1 – 0.5

= 0.5

n =  

n =  

n =  = 384.16

The minimum sample size was 384, but it was adjusted to 423 to account for a 10% non-response rate.

Sampling Technique

A multistage sampling method was used:

1. Stage One: Aba was divided into its main administrative wards.
2. Stage Two: A random selection of wards was conducted using simple random sampling to select 10 wards.
3. Stage Three: From each selected ward, specific neighbourhoods were systematically selected.
4. Stage Four: Within each neighbourhood, households were selected through systematic sampling. A household was defined as a dwelling with at least one married male adult eligible for inclusion.
5. Final Step: In each selected household, one married man was chosen using a simple random selection process (e.g., balloting if more than one eligible man resided).

Inclusion and Exclusion Criteria

Inclusion Criteria

• Married men aged 18 years and above.
• Residents of Aba for at least six months.
• Able to communicate in English or a local language (with the help of a translator where necessary).
• Consenting to participate in the study.

Exclusion Criteria

• Unmarried men.
• Men outside the study area at the time of data collection.
• Married men with cognitive impairments that prevented understanding the questionnaire.

Study Instrument

A structured, interviewer-administered questionnaire was developed based on previously validated instruments from the literature on reproductive health knowledge and attitudes, and adapted to fit the context of IVF. The questionnaire was divided into six sections:

• Section A: Sociodemographic characteristics (age, education, income, religion, number of children, duration of marriage).
• Section B: Knowledge about IVF (definition, purpose, success factors, risks).
• Section C: Attitudes toward IVF (acceptability, willingness to support use, cultural/religious beliefs).
• Section D: Perceptions about IVF outcomes, costs, accessibility, and ethical concerns.
• Section E: Practices & Experience with Infertility/IVF
• Section F: Information Needs and Recommendations

Pre-Testing and Validation

Before the main data collection began, the questionnaire was pre-tested on a sample of 20 married men in a neighbouring community outside the study area to ensure clarity, relevance, and reliability. Based on feedback, ambiguous questions were revised. The reliability of the instrument was assessed using Cronbach’s alpha for attitude and perception items, with a threshold of ≥ 0.70 considered acceptable.

Data Collection Procedure

Data were collected over a four-week period by trained research assistants who were fluent in English and local languages spoken in Aba. The assistants were trained on research ethics, interviewing techniques, and the objectives of the study prior to fieldwork.

Participants were approached at their homes, informed about the study, and written informed consent was obtained before administration of the questionnaire. The questionnaire took approximately 15-25 minutes to complete per participant.

Data Management and Analysis

Completed questionnaires were checked daily for completeness and consistency by the research team. Data were entered into SPSS version 25.0 for analysis. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize sociodemographic characteristics and responses. Participants’ knowledge scores were categorized as good or poor based on predefined cut-off scores. Attitude and perception items were analyzed using frequency distributions and mean scores. Associations between sociodemographic factors and levels of knowledge, attitudes, and perceptions were examined using chi-square tests. A p-value of < 0.05 was considered statistically significant.

Ethical Considerations

Permission was sought from the community leaders in the selected wards of Aba. Participants were informed about the purpose of the study, assured of confidentiality, and made aware that participation was voluntary. Identifiers such as names were not collected to protect privacy. All data were stored securely and accessed only by the research team.

Limitations

Potential limitations of this study include reliance on self-reported information, which may be subject to recall or social desirability bias. Efforts such as assuring anonymity and conducting interviews in private were used to minimize these biases.

RESULTS

The respondents were mostly aged 30–49 years, in monogamous marriages, with 10–14 years of marital duration, and had at least secondary education. Most earned between ₦50,000 and ₦200,000 monthly, were Christian, and had one to two living children, while about one-third reported difficulty having children (Table 1). Awareness of IVF was high, with over four-fifths having heard of it and most demonstrating correct understanding of its purpose, process, limitations, and risks. Overall knowledge was mainly fair to good, with about 47% rated as good or very good (Table 2).

Attitudes were generally positive, as many agreed that IVF is acceptable, should be encouraged, and that men should accept and support its use. Willingness to learn more about IVF was also high (Table 3). Perceptions showed that most respondents believed IVF children are normal and healthy, IVF gives hope to infertile couples, and should be supported by health insurance. However, many perceived IVF as expensive and only moderately accessible locally (Table 4).

Regarding practices, about one-third had undergone fertility testing, fewer reported their wives had received treatment, and about 40% had personally considered IVF. Cost, fear of failure, and lack of information were the most common barriers. Most respondents were willing to attend IVF awareness programs (Table 5). Information needs focused mainly on cost, procedure, access points, and success rates, with hospitals, media, and churches identified as key channels for awareness (Table 6).

Correlation analysis showed significant positive relationships between knowledge, attitude, and perception scores, as well as between income and willingness to use IVF, and education and knowledge. Age had a weak negative correlation with acceptance of IVF (Table 7). Chi-square tests indicated significant associations between education and knowledge level, income and having considered IVF, religion and attitude, and knowledge level and willingness to attend awareness programs (Table 8).

Comparative mean scores showed higher knowledge, attitude, and perception scores among respondents with tertiary education and higher income compared to those with lower education and income levels (Table 9).

 

 

 

DISCUSSION

In vitro fertilization (IVF) is an important option for managing infertility, yet men’s understanding and acceptance can shape uptake and spousal support. This study assessed the knowledge, attitudes, and perceptions of IVF among married men in Aba, Abia State, Nigeria.

The results of this study reveal that knowledge of in vitro fertilization (IVF) among married men in Abia State was moderate, with about half of the respondents demonstrating a fair to good understanding of IVF concepts and procedures. A large majority had heard of IVF and correctly identified the fundamental idea that fertilization occurs outside the body and that IVF is primarily an infertility treatment. Despite this, knowledge gaps remain regarding nuanced aspects such as donor gamete use and success probabilities, suggesting room for improved education. This pattern of moderate awareness aligns with research from Port Harcourt, Nigeria, where 79% of women attending fertility clinics were aware of IVF, yet detailed knowledge varied by specific aspects of the procedure [12]. Similarly, in Cape Coast, Ghana, about two-thirds of women were aware of IVF, and many viewed it as offering hope, though specific misunderstandings persisted [13].

Socio-demographic factors strongly influenced knowledge and attitudes in our study. Education and income positively correlated with knowledge scores, suggesting that men with higher formal education and greater financial resources are better informed and potentially more receptive to IVF. This trend reflects broader patterns in reproductive health literacy where socioeconomic status enhances access to information and shapes health-seeking behaviours. For example, in Nigeria, public awareness and positive attitudes toward assisted reproductive technologies were more common among participants with higher education and income levels, reinforcing the role of socioeconomic status in shaping perceptions of infertility treatments [12].

Our analysis of attitudes toward IVF showed a generally supportive stance among participants. Many respondents agreed that IVF was an acceptable method of having children, would encourage its use by their partners, and felt comfortable discussing it at home. Most agreed that men should undergo fertility testing and that IVF could reduce the stigma of childlessness. This strong positive attitude aligns with findings in other Nigerian populations where a majority expressed willingness to use IVF if needed, though cost and religious beliefs remained significant reservations [14]. The positive link between knowledge and favourable attitudes in our study is supported by literature showing that greater understanding of IVF predicts more positive attitudes toward the procedure [15].

Religious and cultural factors emerged as salient influences on attitudes. Some respondents perceived IVF as conflicting with religious beliefs or divine will, a phenomenon documented in other Nigerian and African studies where traditional and religious interpretations can shape acceptance of assisted reproductive technologies [7]. Despite these concerns, a notable proportion of men disagreed with religious constraints, indicating a pluralistic view where faith and medical intervention can coexist in decision-making about fertility.

Perceptions of the cost and accessibility of IVF were critical. Many respondents felt IVF is too expensive for most families and expressed the belief that it should be supported by health insurance. Perceived high cost has consistently been reported as a major barrier to IVF in low-resource settings, including studies in Nigeria where cost constrained uptake more than awareness or attitude [7]. Only a smaller portion of men agreed that IVF services were readily accessible locally, revealing gaps in geographical and infrastructural access, which could discourage utilization and care-seeking.

Perceptions extended to ethical and social dimensions. Most men believed that children born through IVF are healthy and that IVF gives hope to infertile couples, reinforcing a generally positive reception. However, mixed views persisted on donor sperm/eggs, with a significant minority viewing donor gametes as morally wrong. Such ethical concerns echo findings in other cultural contexts where donor use raises moral and identity questions, even amid broad acceptance of IVF as a treatment option.

Our results on reproductive practices showed that about one-third had undergone fertility testing and nearly 40% had considered IVF personally, indicating active engagement with fertility issues beyond abstract awareness. Barriers identified, especially cost, fear of failure, lack of information, and cultural reasons, are consistent with global reports where financial, psychosocial, and informational constraints inhibit the pursuit of assisted reproductive technologies, particularly in low- and middle-income contexts.

The high willingness to attend IVF awareness programs and the expressed desire for more information on cost, success rates, procedures, risks, and access points highlight an unmet need for tailored education and community sensitization. Studies in similar contexts emphasize the value of structured awareness campaigns to dispel myths, increase health literacy, and improve health outcomes [12].

Correlation analysis further clarifies the interconnectedness of knowledge, attitudes, perceptions, and socio-demographic factors. We found a moderate positive correlation between knowledge and attitude scores, and between knowledge and perception scores. These findings mirror research indicating that increased knowledge often predicts more positive attitudes and perceptions toward IVF [15]. The strong positive correlation between attitude and perception underscores how cognitive and affective components together shape overall receptivity to fertility treatments. The significant positive associations of income with willingness to use IVF highlight the economic dimension in reproductive decision-making.

Our findings also suggest age may play a role in acceptance of IVF, with a weak negative correlation indicating that younger respondents may be slightly more open to assisted reproductive technologies. Although age did not reach statistical significance in chi-square analysis, the trend aligns with other studies where younger individuals tend to be more receptive to medical interventions that challenge traditional norms.

CONCLUSION

The findings of this present study demonstrate that married men in Abia State generally possess moderate knowledge, positive attitudes, and mixed perceptions about IVF, shaped by educational, economic, cultural, and religious factors. While attitudes and willingness to use IVF are promising, gaps in detailed knowledge, persistent misconceptions, cost barriers, and access challenges underline the need for public health strategies focused on education, affordability, and supportive counselling. These findings are consistent with research from Nigeria and other African settings, reinforcing the broader relevance of addressing informational and structural barriers to improve acceptance and access to fertility treatments.

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