Couples on N70,000 minimum wage can’t afford fertility treatment — Specialists

Fertility treatment. | Credit: AFRH

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Fertility specialists say several factors continue to make fertility treatment unaffordable for many low-income Nigerian couples battling infertility, despite the World Health Organisation’s new guideline urging countries to make fertility care more accessible and affordable.

They argue that Nigeria’s economic realities and the condition of its healthcare system make equitable access to fertility care extremely difficult.

Evidence shows that three out of every 10 Nigerian couples experience some form of infertility.

The experts spoke in reaction to the WHO’s first global guideline on infertility, which advises countries to make fertility care safer, fairer, and more affordable.

The guideline contains 40 recommendations to strengthen the prevention, diagnosis, and treatment of infertility. It promotes cost-effective options at every stage and advocates integrating fertility care into national health strategies, services, and financing frameworks.

“Infertility is one of the most overlooked public health challenges of our time and a major equity issue globally. Millions face this journey alone, priced out of care, pushed towards cheaper but unproven treatments, or forced to choose between their hopes of having children and their financial security.

“We encourage more countries to adopt this guideline, giving more people the possibility to access affordable, respectful, and science-based care,” WHO Director-General, Dr Tedros Ghebreyesus, said.

A new WHO report estimates that around 17.5 per cent of adults—roughly one in six worldwide—experience infertility. The Association for Fertility and Reproductive Health also estimates that Nigeria has about 12 million infertile persons, representing almost 10 per cent of the population.

However, specialists who spoke to PUNCH Healthwise said Nigeria’s weak health system and poor economic conditions may hinder the guideline’s implementation, especially regarding affordability.

The President of the Association for Fertility and Reproductive Health, Prof. Preye Fiebai, noted that without universal health coverage, couples facing infertility would continue to face financial barriers when seeking reproductive care at facilities across the country.

Fiebai stressed that many Nigerian couples requiring the treatment do not have the financial capacity to pay for fertility treatment, especially when advanced reproductive technologies become necessary.

“Many do not have the financial capacity to pay for the care they need. In many cases, after exhausting conventional treatments, patients may require assisted reproduction, which is not cheap,” he said.

He noted that the dominance of private fertility centres further complicates affordability for ordinary citizens, as fees far exceed what many households earn.

“Most services are offered in private institutions. Only a few public institutions provide reproductive technology, and even in those places, the cost is still beyond the reach of the average Nigerian. Minimum wage is N70,000, yet consultation and treatment fees far exceed that. Things need to be balanced,” he added.

The fertility specialist said the national conversation on making fertility care safer, fairer, and more affordable, in line with the WHO guideline, must begin with a realistic assessment of Nigeria’s economic reality.

He argued that achieving affordability in isolation is impossible when even basic healthcare remains inaccessible to millions of Nigerians.

“And that brings us back to the same issue: if other aspects of healthcare remain unaffordable, infertility care will not suddenly become affordable. Until we achieve universal health coverage, progress will be difficult,” he said.

According to him, the country cannot properly address infertility when it struggles to provide basic treatment for conditions such as malaria.

“How do we begin to address infertility when we can’t even provide basic services? The economy is in a terrible state, and until these basic issues are fixed, we can’t even scratch the surface in the management of infertility,” he said.

He noted that those who can afford fertility care eventually seek it, but equity remains impossible without a health insurance structure capable of supporting the vulnerable.

“But for us to talk about equity and fair access, we must first fix universal health coverage,” he said.

Fiebai warned that the WHO guidelines, though important, do not automatically translate into access for Nigerian families.

“Their reality, especially in relation to the recent WHO guidelines, is tied directly to the economic situation. Guidelines only state how patients should be treated; they do not automatically translate to access,” he said.

Fiebai insisted that Nigeria must first fix its economic challenges and revamp its health system before expecting affordable infertility care.

“We must first correct the economic situation of the country and get the health system working before anything else can follow. Until all these issues are addressed, I am sorry to say, the guidelines will not achieve much,” he said.

Also speaking, the Second Vice President of the Society of Gynaecology and Obstetrics of Nigeria, Prof. Christopher Aimakhu, noted that there are conditions that threaten lives daily that would be prioritised by the government before considering infertility treatment.

“Infertility, first of all, is not a disease. It is not something you make compulsory for everybody because it is not a condition affecting a large portion of the population,” he said.

Aimakhu explained that fertility care involves complex investigations and procedures that require significant funding, equipment, and skilled manpower.

“For fertility care to be done, you need funds. Unless the government sees it as a pressing medical issue that affects many people, and prioritises it above several other important health conditions, fertility care cannot suddenly become affordable,” he said.

He noted that for financing options to work, fertility care must be included in the national health insurance scheme.

“Somebody must pay for it. Fertility care is not like malaria treatment or immunisation, where you can roll out a programme for everybody. It is highly specialised care,” he added.

Aimakhu stressed that without adequate facilities, modern technology, and properly trained personnel nationwide, affordability cannot be at the forefront.

“You cannot talk about cost or financing until treatment options are established, personnel are trained, centres are created, and the service is made a priority,” he said.

Aimakhu added that the shortage of fertility specialists and other trained professionals further limits access.

“Most specialists in this field are limited, and beyond doctors, you also need other cadres of trained professionals. These resources are not readily available to everyone,” he explained.

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