“Have you considered adoption? What are you guys waiting for? Don’t you know you are getting old? I want my grandchildren”, are amongst the triggers infertile and sub-fertile couples have to confront in their day to day survival.

This barrage of questions comes in addition to the couple’s innate fears and uncertainty as a result of delayed childbirth.

Infertility is hard to deal with, and in Ghana, our society often plays the untoward role of aggravating the pain of the infertile couple.

What is infertility? Infertility is a reproductive health disease defined by the World Health Organisation as a failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

A myriad of factors contributes to infertility. Predominant amongst this include endometriosis, azoospermia or oligozoospermia, premature ovarian insufficiency, polycystic ovarian syndrome (PCOS), Klinefelter’s syndrome, and cystic fibrosis.

Like cancer, diabetes, malaria, amongst others, infertility is a disease of the body.

However, patients of this condition have been treated by society, especially the African society, as outcasts.

In certain African cultures, couples with infertility are treated as outcasts of the society, unfortunately with the women being disproportionately affected by this ill-treatment.

In some societies, mostly rural, women dealing with infertility are forced to live lonely lives as they are mostly ignored due to pervasive notions that they are associated with some form of bad luck.

Some of these women face abuse and are given labels such as ‘fruitless trees’, ‘witches’, ‘demons’ and ‘children-eaters’.

The woes of infertile women, and also sub-fertile women (women who experience a delay in conception) remain pronounced regardless of societal status, ethnicity, or tribe.

In the Ghanaian society, many perceive a woman’s success as heavily reliant on her ability to get married and have children.

This perception still holds in the 21^st century, in spite of society becoming increasingly cognisant and reaching tapering heights of education and literacy.

“The perception that women are largely responsible for infertility has fuelled the notion that the burden of reproduction solely lies on the female partner.

On the contrary, research has shown that male and female causes of infertility account for 50% each of the total infertility burden worldwide.”

Unfortunately, in many cases, the male is presented the option to leave his infertile/ sub-fertile wife and engage other women as a solution for the predicament, eventually creating instability in the home which births a cascade of emotional, physical, and verbal abuse, again mostly affecting the female partner.

Research has shown this situation is associated with increased levels of depression, anxiety, insomnia, and other physical and psychological issues in infertile couples, again especially in female partners.

As a result of the ensuing desperation, in addition to increased societal pressure, most of these couples are coerced to seek unverified treatment options that may expose them to further health risks.

The prevalence of infertility in Ghana is estimated at about11-16%.

However, this figure has been suggested as an underestimation of the true burden of infertility as many infertile and sub-fertile couples are hesitant about disclosing their true status for fear of discrimination and ostracization.

Data on infertility and sub-fertility in Ghana remains insufficient, however, studies on the general trends of fertility and fecundity on the African continent show a decreasing incidence on the continent.

Infertility has been described as both a disease and public health concern by the WHO, therefore reinforcing the need for public health systems to put measures in place such that treatment options are available and accessible to the average Ghanaian.

Today, IVF treatment is the route for reproduction for many, and has proven useful for a wide range of patient groups beyond infertile or sub-fertile couples.

For example, egg freezing offers people undergoing cancer treatment the chance to have children of their own later, thus bypassing the risk of later infertility due to chemotherapy, radiotherapy and other potentially harmful treatments.

Further, techniques such as pre-implantation genetic testing for genetic disorders, allow individuals who carry certain genetic diseases to have children with a decreased risk of inheriting parental conditions.

In Africa, a known high spot of sickle cell anaemia, introducing IVF and genetic testing techniques subsequently, will be beneficial as preventive medical interventions for sickle cell anaemia.

It is estimated that sickle cell anaemia alone costs an average of about $26,000 per patient lifetime treatment in addition to unaccounted costs of loss of lives, and untapped human resource potential.

This is at least twice the cost of genetic testing as a preventive measure for sickle cell anaemia, thus providing more reason for a shift towards IVF and its associated technologies.

The general behavioursand perceptions of Ghanaians towards infertility and its treatment options generally tends to be negative.

IVF is wrongly perceived as harmful to infertile and sub-fertile couples, as only for the rich, or for people who want to practice sex selection.

Mass education is the first of many steps required to correct such misconceptions. Further actions vital to rectifying this include putting in place laws that protect the infertile couple from abuse and discrimination.

We should also increase the availability of treatment options to the average Ghanaian, firstly by incorporating infertility treatment into public healthcare, and secondly by providing government subsidies and insurance cover for such treatment.

The fields of assisted reproductive treatment (ART) and embryology have grown beyond the confines of infertility treatment, offering preventive medicine options for genetic conditions, treatment for leukemia via saviour siblings, amongst others.

As a nation, it is about time we prioritised ART and explored the field for preventive medicine purposes as well. At the same time, it is important that mass education of the Ghanaian society takes place to correct widely held misconceptions which encourage stigmatisation and mistreatment of infertile and sub-fertile couples.

“…it is important that mass education of the Ghanaian society takes place to correct widely held misconceptions which encourage stigmatisation and mistreatment of infertile and sub-fertile couples.”

Lastly, it is imperative that laws are put in place to protect infertile and sub-fertile couple, especially those in vulnerable regions who suffer discrimination, abuse, and social exclusion.

Rather than stigmatising the infertile and sub-fertile couple, we all have a role to play in creating a community that protects and supports them.

¹Arhin, S.M., Mensah, K.B., Agbeno, E. et al. Pharmacotherapy of infertility in Ghana: a retrospective study at the Cape Coast Teaching Hospital. J of Pharm Policy and Pract 12, 28 (2019).