In Nigeria, the pressure to have children is immense. For couples struggling to conceive, the emotional weight of infertility, compounded by family expectations, cultural stigma, and widespread misinformation, can be devastating. Many couples spend years trying herbs, prayers, and unproven remedies before ever seeing a medical professional. By the time they do, opportunities for simpler, earlier interventions may have been missed.
Infertility is a medical condition, not a spiritual punishment, not always the woman’s fault, and not the end of the road. This article explains what infertility actually is, its most common causes in Nigeria, what investigations are needed, and what options are available. Because the first step to finding a solution is understanding the problem.
What Is Infertility?
Infertility is defined as the failure to achieve a clinical pregnancy after 12 months of regular unprotected sexual intercourse in women under 35. For women aged 35 and above, the threshold is reduced to 6 months because age significantly affects fertility and earlier investigation is warranted.
Primary infertility: The couple has never achieved a pregnancy.
Secondary infertility: The couple has previously achieved a pregnancy (which may or may not have resulted in a live birth) but is unable to conceive again. Secondary infertility is extremely common in Nigeria and often linked to complications from previous pregnancies, abortions, or untreated infections.
Infertility is more common than most people realise. According to the World Health Organization, approximately 1 in 6 people globally are affected by infertility at some point in their reproductive lives.
Is Infertility Always the Woman’s Problem?
No, and this is one of the most important misconceptions to address directly.
In approximately:
- 35-40% of cases, the cause is found in the woman alone
- 35-40% of cases, the cause is found in the man alone
- 20-30% of cases, both partners have contributing factors
- 10-15% of cases, no cause is identified after full investigation (unexplained infertility)
This means that in roughly half of all infertility cases, the man is either the sole cause or a contributing factor. Yet in Nigeria, infertility investigations almost universally begin and often end with the woman. Men frequently refuse testing entirely, citing cultural beliefs about masculinity or the assumption that if they have fathered children before, they cannot be infertile.
Both partners must be investigated simultaneously. Investigating only the woman while leaving the man untested wastes time, money, and emotional energy.
Common Causes of Female Infertility in Nigeria
1) Tubal Factor Infertility – The Most Common Cause in Nigeria
Damage or blockage of the fallopian tubes, the tubes that carry eggs from the ovaries to the uterus, is the leading cause of female infertility in Nigeria. Blocked tubes prevent sperm from reaching the egg, and even if fertilisation occurs, a blocked tube can trap the embryo, causing a life-threatening ectopic pregnancy.
The primary cause of tubal damage in Nigeria is pelvic inflammatory disease (PID), an infection of the reproductive organs, most commonly caused by untreated chlamydia, gonorrhoea, or other bacterial infections. Because STIs are frequently silent (no symptoms), many Nigerian women have had PID without ever knowing it, and discover the resulting tubal damage only when they try to conceive.
Previous abdominal surgery, ruptured appendix, and complications from unsafe abortions also cause tubal scarring.
2) Polycystic Ovary Syndrome (PCOS)
PCOS is a hormonal condition in which the ovaries produce excess androgens (male hormones), disrupting normal ovulation. Women with PCOS ovulate irregularly or not at all, making conception difficult. PCOS is one of the most common causes of infertility in Nigerian women and is significantly underdiagnosed. Signs include irregular or absent periods, excess facial or body hair, acne, and weight gain, though many women have PCOS with minimal external signs.
3) Uterine Fibroids
As covered in our fibroid article, fibroids, particularly submucosal fibroids inside the uterine cavity, interfere with implantation of a fertilised egg. Nigerian women have some of the highest fibroid rates in the world.
4) Endometriosis
A condition where tissue similar to the uterine lining grows outside the uterus on the ovaries, fallopian tubes, and surrounding structures. It causes scarring, adhesions, and inflammation that interfere with egg release, fertilisation, and implantation. Endometriosis is significantly underdiagnosed in Nigeria; many women with painful, heavy periods and fertility challenges have never been investigated for it.
5) Premature Ovarian Insufficiency (POI)
The ovaries stop functioning normally before age 40, causing irregular or absent periods and low egg reserves. Can be genetic, autoimmune, or caused by previous chemotherapy or radiation.
6) Age-Related Decline in Egg Quality and Quantity
Female fertility declines progressively from the mid-30s and more sharply after 37. Egg quality and quantity both decline, reducing the chances of conception and increasing the risk of miscarriage. This is not a myth; it is a biological reality. Women who plan to delay childbearing should be aware of this timeline and consider fertility preservation options if appropriate.
7) Cervical Factors
Abnormalities of the cervical mucus too thick, too hostile to sperm, or insufficient can prevent sperm from reaching the egg. Cervical scarring from previous procedures or infections can also contribute.
8) Thyroid and Other Hormonal Disorders
Thyroid disorders, both underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid disrupt hormonal balance and can prevent ovulation. Elevated prolactin levels (hyperprolactinaemia) also suppress ovulation. Both are common, treatable, and frequently missed in infertility workups.
Common Causes of Male Infertility in Nigeria
1) Low Sperm Count (Oligospermia) and Poor Sperm Quality
The most common male infertility finding. A normal semen analysis shows at least 15 million sperm per millilitre, with at least 40% moving and at least 4% with normal shape. Abnormalities in count, motility (movement), or morphology (shape) all reduce the chances of fertilisation.
2) Azoospermia
Complete absence of sperm in the semen. Can be caused by obstruction of the sperm transport ducts or by failure of sperm production in the testes. Requires specialist investigation.
3) Varicocele
Enlarged veins in the scrotum (similar to varicose veins in the leg) that raise testicular temperature and impair sperm production. The most common correctable cause of male infertility globally. Can be treated surgically with significant improvement in sperm parameters.
4) Sexually Transmitted Infections
Untreated gonorrhoea, chlamydia, and other STIs can cause scarring of the sperm ducts in men, blocking sperm transport. As with women, these infections are frequently silent.
5) Hormonal Factors
Low testosterone, elevated prolactin, or abnormalities of FSH and LH can impair sperm production. Treatable with appropriate hormonal management.
6) Lifestyle Factors
- Alcohol: significantly reduces testosterone and sperm quality
- Smoking: damages sperm DNA and reduces count and motility
- Heat exposure: prolonged exposure to heat (hot baths, laptops on the lap, tight underwear, certain occupations) impairs sperm production; sperm require slightly below body temperature
- Anabolic steroids: commonly used by men seeking to build muscle, anabolic steroids severely suppress natural testosterone and sperm production, sometimes permanently
7) Previous Mumps Orchitis
Mumps infection in adulthood can cause orchitis (inflammation of the testes) that permanently damages sperm production. A significant cause of male infertility in Nigeria where childhood vaccination against mumps is not universal.
Essential Investigations for Infertility
A proper infertility workup investigates both partners simultaneously. Arriving at a clinic alone without your partner is not a complete infertility assessment.
For Women
- Hormonal profile: FSH, LH, oestradiol, progesterone (day 21), prolactin, thyroid function tests (TSH), AMH (anti-Müllerian hormone measures egg reserve)
- Pelvic ultrasound: Assesses the uterus for fibroids and structural abnormalities; the ovaries for PCOS or cysts; and antral follicle count (a measure of egg reserve)
- Hysterosalpingography (HSG): An X-ray procedure in which dye is injected through the cervix into the uterus and fallopian tubes to check for tubal patency (open vs blocked tubes). Essential for ruling out tubal factor infertility.
- STI screening: Chlamydia, gonorrhoea, HIV, Hepatitis B and C
- Fasting blood glucose and insulin resistance tests: Particularly for PCOS
- Laparoscopy: Surgical camera investigation of the pelvis; the definitive test for endometriosis and can also assess tubes and ovaries directly. Recommended when non-invasive tests are normal, but infertility persists.
For Men
- Semen analysis: The most important first test for male infertility. Analyses sperm count, motility, morphology, volume, and other parameters. Should be done at a reputable laboratory with WHO reference standards. One abnormal result should be confirmed with a second test after 2–3 months (the time for new sperm to be produced).
- Hormonal profile: FSH, LH, testosterone, prolactin
- Scrotal ultrasound: Checks for varicocele and testicular abnormalities
- STI screening
- Genetic testing: For men with very low or absent sperm, chromosomal or genetic analysis may be needed
Treatment Options
Treating Underlying Causes
Many causes of infertility are directly treatable:
- PCOS: Lifestyle changes, weight loss (very effective in overweight women with PCOS), ovulation induction medications (clomiphene, letrozole), metformin
- Thyroid disorder / hyperprolactinaemia: Medication restores normal hormonal balance and often restores ovulation
- Tubal blockage: Surgical tubal surgery (tuboplasty) or bypassing the tubes entirely with IVF
- Fibroids: Myomectomy where indicated
- Varicocele: Surgical repair (varicocelectomy) improves sperm parameters in many men
- Hormonal male infertility: Hormonal treatment to stimulate sperm production
Ovulation Induction
For women who are not ovulating regularly, particularly those with PCOS, oral medications (clomiphene citrate or letrozole) stimulate the ovaries to produce and release eggs. Simple, affordable, and effective for many women.
Intrauterine Insemination (IUI)
Processed, concentrated sperm is placed directly into the uterus at the time of ovulation, bypassing the cervix and reducing the distance sperm must travel. Used for mild male factor infertility, unexplained infertility, and where cervical mucus is a problem.
In Vitro Fertilisation (IVF)
Eggs are retrieved from the ovaries, fertilised with sperm in a laboratory, and the resulting embryos are transferred into the uterus. IVF bypasses tubal factors entirely and is the most effective assisted reproductive technology. It is available in Nigeria in Lagos, Abuja, and other major cities, though the cost remains significant. Success rates depend heavily on the woman’s age and the quality of the clinic.
Intracytoplasmic Sperm Injection (ICSI)
A specialised form of IVF in which a single sperm is injected directly into an egg, used for severe male factor infertility, including very low sperm counts or poor motility.
Infertility Myths in Nigeria
“Infertility is always the woman’s fault.” False. Male factor is involved in approximately half of all infertility cases. Both partners must be tested.
“If you’ve been pregnant before, you can’t be infertile.” False. Secondary infertility, the inability to conceive after a previous pregnancy, is extremely common. Conditions like tubal damage from infections or complications can develop after previous pregnancies.
“Herbal fertility treatments work.” No scientific evidence supports any herbal preparation for improving fertility. Some are actively harmful to reproductive organs or the liver. Years spent on herbal treatments are years of declining egg quality and untreated medical causes.
“IVF always produces twins or triplets.” Not necessarily, and modern practice aims to transfer single embryos where possible to reduce the risk of multiple pregnancies and their complications.
“Stress causes infertility.” Stress alone rarely causes infertility, though it can affect libido and sexual frequency. The primary causes of infertility are medical, not emotional. Telling a struggling couple to “just relax” is not only unhelpful, it is also dismissive of a genuine medical condition.
“Women over 40 cannot conceive.” False, though fertility is significantly reduced. Women over 40 can and do conceive, both naturally and with assisted reproduction. Egg donation from younger donors further improves success rates for older women.
“A man who can have sex can definitely father children.” False. Sexual function and fertility are entirely separate. A man can have normal erections and ejaculation with zero viable sperm in his semen.
Nigeria-Specific Context
- The STI burden in Nigeria, particularly untreated chlamydia and gonorrhoea, is the single biggest preventable cause of female tubal infertility in the country
- Many Nigerian couples wait 3–5 years before seeking medical help, by which time egg quality has declined and simpler treatments are less effective
- Cultural and family pressure often leads women to pursue multiple herbal treatments, traditional healers, and spiritual interventions before medical care
- Male refusal to undergo semen analysis is a significant barrier; framing it as “finding out the full picture together” rather than “testing the man” sometimes helps
- IVF is available in Nigeria but remains expensive and emotionally demanding; correct diagnosis and treatment of underlying causes first may make IVF unnecessary for many couples
- The Nigerian medical community is growing in fertility expertise; specialist fertility clinics in Lagos offer world-class care
When to Seek Help
- Under 35: Seek assessment after 12 months of unprotected regular sex without conception
- 35-37: Seek assessment after 6 months
- Over 37: Seek assessment after 3 months or immediately if there are known risk factors
- Any age: Seek assessment immediately if you have known risk factors: irregular periods, previous STI, previous ectopic pregnancy, known fibroids or PCOS, previous pelvic surgery, or significant male risk factors
Quick Summary
| Definition | No pregnancy after 12 months of regular unprotected sex (6 months if over 35) |
| Is it always the woman? | No, a male factor is involved in ~50% of cases |
| Leading female cause in Nigeria | Tubal damage from untreated STIs |
| Leading male cause | Poor sperm quality; varicocele |
| Essential first tests | Hormonal profile + pelvic ultrasound (woman); semen analysis (man) |
| Most important myth to bust | Both partners must be tested, not just the woman |
| Treatment options | Depends on cause, from medication to IUI to IVF |
Bottom Line
Infertility in Nigeria is common, complex, and consistently mismanaged not because solutions do not exist, but because couples spend years on the wrong path before reaching proper medical care. The earlier you seek a proper diagnosis, the more options you have. Both partners need to be investigated. The cause needs to be identified before treatment begins. And evidence-based medical care, not years of herbal remedies, gives you the best chance of achieving the family you want.
Book a fertility assessment for you and your partner at Pretty Healthcare, Ikeja, Lagos – prettyhealthcare.com.ng/diagnostics or chat with our health advisor on WhatsApp. Monday – Friday: 8 am – 5 pm | Saturday: 9 am – 4 pm.
