Factors Influencing the Decision to Use in vitro Fertilisation among Infertile Couples Attending Public Tertiary Health Facilities in Abia State, Nigeria

Abstract

Background: Infertility remains a major reproductive health concern in Nigeria, and in vitro fertilization (IVF) is increasingly considered by couples who have not achieved conception through conventional treatments. However, decisions to use IVF are shaped by multiple interacting factors. Aim: This study assessed the socio-demographic, reproductive, knowledge-based, attitudinal, economic, and health system factors influencing the decision to use IVF among infertile couples attending Abia State University Teaching Hospital (ABSUTH), Aba, and Federal Medical Centre (FMC), Umuahia. Methods: A multi-facility cross-sectional analytical study was conducted among 368 infertile couples attending the infertility clinic at ABSUTH and FMC, Umuahia. Systematic random sampling was used. Data were collected with a pretested structured interviewer-administered questionnaire covering socio-demographics, reproductive history, IVF knowledge, attitudes and beliefs, economic considerations, and health system factors. Data were analysed using SPSS version 25. Descriptive statistics were generated, Chi-square tests assessed associations, Pearson correlation examined relationships among key variables, and logistic regression identified independent predictors of the decision to use IVF. Statistical significance was set at p < 0.05. Results: The mean age distribution showed that most respondents were 25–39 years. Overall, 57.9% of couples had decided to pursue IVF. Higher educational level, income, duration and type of infertility, religious support, and quality of counselling were significantly associated with IVF decision (p < 0.05). Knowledge and attitude toward IVF were positively correlated (r = 0.46, p < 0.001). Logistic regression revealed that tertiary education (AOR = 2.41; 95% CI: 1.38–4.21), high income (AOR = 3.17; 95% CI: 1.84–5.46), good IVF knowledge (AOR = 2.86; 95% CI: 1.67–4.89), positive religious belief (AOR = 1.98; 95% CI: 1.12–3.49), and adequate counseling (AOR = 3.42; 95% CI: 1.96–5.98) were independent predictors of the decision to use IVF. Conclusion: The decision to use IVF among infertile couples in Abia State is strongly influenced by education, income, knowledge, religious beliefs, and quality of counseling. Strengthening patient education, improving access to affordable IVF services, and enhancing counseling quality may improve informed uptake of IVF among eligible couples.