Assisted Pregnancy: Navigating the Secret Struggle Between Faith and Fertility Science Among Nigerian Christians – Part I

By Julius Nsikak

Faith, Stigma and Silent Burden of Infertility Among Nigerian Christian Couples

An estimated 2.5 million naira. That is the average cost of a standard In vitro Fertilisation (IVF) (Latin for “In glass”, meaning fertilisation outside the human body in a laboratory) cycle in Nigeria, a figure that places assisted conception beyond the reach of many households already burdened by rising living costs and prolonged fertility struggles.

Yet cost is only one part of a much larger crisis. Fertility specialists estimate that between 15 and 25 per cent of couples in Nigeria and across sub-Saharan Africa may experience infertility at some point during their reproductive lives, with secondary infertility remaining particularly common.

For countless couples, the dream of parenthood now carries a price tag that demands not only emotional endurance but also overwhelming financial sacrifice. Even for those who manage to raise the funds for a first IVF attempt, success is not guaranteed. Fertility specialists note that a single IVF cycle may offer success rates ranging from 30 to 55 per cent, depending largely on age, embryo quality, and underlying medical conditions. Women under the age of 35 generally achieve better outcomes, while success rates decline significantly after age 40 due to reductions in egg quantity and quality.

It is within this complex reality that Nigeria’s fertility crisis unfolds, where science offers possibility, but affordability determines access; and where the desire for a child increasingly collides with financial limitations, social pressure, religious expectations and widespread misconceptions about infertility itself.

In modern Nigeria, where religion often shapes personal decisions as strongly as culture and tradition; infertility has quietly become one of the most emotionally devastating realities confronting many Christian couples.

Behind public testimonies, prophetic declarations, thanksgiving services, and child dedication  ceremonies lie a growing population of families privately struggling with infertility, moving between prayer houses and fertility clinics in search of hope, healing, and acceptance.

For many couples, the journey is marked not only by medical uncertainty but also by social pressure, spiritual expectations, and emotional exhaustion. While advances in reproductive medicine have created new pathways to parenthood, conversations around infertility remain shrouded in silence, stigma, and misunderstanding.

This investigation examines the uneasy intersection involving religious doctrine, social expectations, and assisted reproductive technologies such as in vitro fertilisation and surrogacy. Although these medical interventions have helped millions of families globally and thousands within Nigeria, many Christian couples continue to approach them discreetly because of fears of condemnation, doctrinal resistance, and judgement within the faith communities.

For many of these couples, that fear is not abstract. It is deeply personal, and it begins with the belief that seeking medical help for infertility may be interpreted as a sign of spiritual weakness

The Fear of Being Seen as Spiritually Weak

For many Christian couples who have waited years for babies, IVF and surrogacy now represent possible pathways to parenthood and emotional restoration. Yet for numerous families, the fear of judgement within religious circles remains stronger than the willingness to openly seek fertility treatment.

Some affected couples reportedly undergo fertility procedures in secrecy, unwilling to disclose the source of their pregnancies because of fears that church members may interpret assisted conception as evidence of weak faith, spiritual failure, or disobedience to divine will.

Others spend years attending vigils, fasting events, deliverance sessions, and prophetic consultations before eventually considering medical intervention. In some instances, infertility is framed entirely as a spiritual attack, delaying proper medical diagnosis and treatment for years. The consequences can be significant. Medical experts have repeatedly warned that delayed fertility evaluation may reduce the chances of successful conception, particularly as age advances. Yet among some Christian communities, infertility remains a deeply spiritualised issue, creating an environment where couples often feel compelled to prove their faith before exploring medical options.

What IVF and Surrogacy Involve

In vitro fertilisation, commonly known as IVF, is a reproductive procedure in which  an  egg (ovum)  is  fertilised by  sperm outside the human  body, usually  in  a laboratory, before the resulting embryo is transferred into the uterus. The world’s first successful IVF birth occurred in England in 1978 with the birth of Louise Brown under the care of fertility specialists Robert Edwards and Patrick Steptoe.

Surrogacy, on the other hand, involves an arrangement in which a woman agrees to carry and deliver a newborn on behalf of another individual or couple who may be unable to conceive or sustain a pregnancy naturally. The practice gained global attention in the 1980s following the widely publicised ‘Baby-M’ case in the United States, which sparked international legal and ethical debates surrounding surrogacy.

Operationally, IVF refers to assisted reproductive technology used to address infertility through laboratory fertilisation, while surrogacy refers to the carrying of a pregnancy by another woman for intended parents. In Nigeria, the first officially documented IVF baby was Olushina Egbosa Oluwaremilekun Oni, born on March 17, 1989, at Lagos University Teaching Hospital through a procedure conducted by Professors Osato Giwa-Osagie and colleagues.

Another major milestone occurred on February 11, 1998, when Hannatu Kupchi was born through IVF at NISA Premier Hospital in Abuja under the supervision of Dr Ibrahim Wada. These successes helped establish Nigeria as one of Africa’s early adopters of assisted reproductive technology and paved the way for the gradual expansion of fertility treatment services in Lagos, Abuja, Port Harcourt and other urban centres. Unlike IVF, surrogacy developed more quietly.

Although isolated arrangements reportedly existed earlier, surrogacy became more visible in Nigeria during the early 2000s as fertility clinics expanded their services. By the 2010s, the practice had gained broader public attention, particularly among wealthy families, celebrities, and Nigerians living abroad seeking alternatives to infertility challenges.

However, cultural stigma, religious concerns, and the absence of a comprehensive regulatory framework ensured that many arrangements remained private and largely undocumented. Among notable cases, Ajibola Otunbusin drew national attention after reportedly giving birth through IVF following nearly four decades of infertility.

More recently, actress Ini Edo publicly disclosed that she turned to surrogacy after multiple miscarriages and unsuccessful IVF attempts, igniting widespread discussions about infertility, reproductive choices, and societal judgement. Also, author Chimamanda Ngozi Adichie’s use of surrogacy became public knowledge following reports surrounding the birth of her twin children, while media personality Stephanie Coker has openly discussed her own fertility struggles and IVF experience.

These disclosures have helped normalise conversations around assisted conception in a society where infertility is often treated as a private burden. Global Studies by the International Committee Monitoring Assisted Reproductive Technologies (ICMART), publicised by organisations like ARC Fertility show that more than ten million babies have reportedly been born through IVF since the first successful procedures in the late 20th century. Industry projections by the National Institute of Health indicates that the global surrogacy market is expected to reach approximately 27.9 billion dollars, driven by rising infertility rates, delayed childbearing, and advances in reproductive medicine.

Nigeria has similarly witnessed remarkable growth in fertility services. Investigative findings by lawyer and health law scholar, Olatunde Sanu indicate that the country now has more than 174 fertility clinics nationwide, with an estimated 18,850 IVF cycles carried out in 2023 alone. Despite these developments, the rapid growth of fertility services has not been matched by equivalent public understanding. One of the strongest concerns raised by fertility experts is the persistence of misconceptions surrounding both IVF and surrogacy.

 

The Misconceptions

In an email correspondence with this reporter, Laura Calder, Communications and Content Manager of Embrymama, an international surrogacy centre headquartered in Abu Dhabi, United Arab Emirates, said many people continue to view surrogacy as a guaranteed solution to infertility. According to her, this expectation often creates emotional difficulties for intended parents.

“Many intended parents come to surrogacy after years of unsuccessful IVF cycles, pregnancy losses, emotional exhaustion, and financial pressure. They naturally hope surrogacy will finally guarantee success. However, surrogacy is still a pregnancy, and like any pregnancy, it carries medical risks, uncertainties, and possible complications,” she said.

Calder stressed that there is no guarantee at any stage of the process, whether during embryo transfer, implantation, pregnancy or delivery. She also challenged a common assumption that surrogate mothers may become attached to babies and refuse to surrender them after birth. According to her, gestational surrogacy involves a surrogate mother who has no genetic relationship with the child because she does not provide her own eggs.

“In our experience, surrogate mothers understand this clearly. They enter the programme consciously, with a full understanding of their role, and they are usually happy to help intended parents achieve their dream of having a child,” she explained.

The fertility advocate further rejected stereotypes portraying surrogate mothers as irresponsible women motivated solely by financial gain. Instead, she described many surrogates as highly responsible women who take the process seriously and view it as an opportunity to support their families while helping another family achieve parenthood.

According to Calder, another widespread misunderstanding is the belief that surrogacy is primarily a matter of convenience. She argued that in most jurisdictions where surrogacy is regulated, intended parents must demonstrate genuine medical reasons, including repeated pregnancy losses, serious health risks, or an inability to carry a pregnancy safely. “For most intended parents, surrogacy is not a lifestyle choice. It is often the last available path to parenthood after years of struggle,” she said.

Her observations highlight a recurring theme throughout this investigation: that is the gap between public perceptions of fertility treatment, and the realities of infertility.

Medical Perspectives on Fertility Challenges

Dr. Joan Powei Ogbode, a medical practitioner and Deputy Director of Clinical Services at the University of Uyo Medical Centre, attributed many fertility challenges among  Nigerian  couples to  factors such  as  advancing  age, poor understanding of ovulation, and limited access to fertility education. Speaking on fertility care and reproductive health issues, she said infertility is typically investigated after a couple has engaged in regular unprotected sexual intercourse for one year without achieving pregnancy.

Age, according to her remains a major determinant of fertility outcomes as the likelihood of conception declines over time. She explained that successful pregnancy depends on the meeting of sperm and egg, a process that becomes more difficult as the reproductive window shortens. She further noted that many couples lack adequate knowledge of ovulation, leading to missed fertile periods.

Many women, she said, do not recognise the signs of ovulation and may mistake them for illness. She explained that if intercourse does not occur within the fertile window, the chances of conception are significantly reduced. She also stressed that male partners played an important role in timing, noting that cooperation between both partners was essential because the egg is available only once in a monthly cycle.

On religious influence, Dr. Ogbode observed that fertility decisions were often shaped by personal conviction and denominational beliefs. She noted that while some religious groups were open to assisted reproductive technologies, others express reservations about procedures such as in vitro fertilisation and surrogacy. However, she added that infertility should be treated as a shared medical concern between couples rather than an issue defined solely by faith.She said faith remains personal and should be distinguished from medical decision making. According to her, couples must make informed choices based on both belief and available medical options rather than relying solely on spiritual expectations.

Dr. Ogbode identified cost as one of the most significant barriers to fertility treatment in Nigeria. She estimated that a standard in vitro fertilisation cycle costs about 2.5 million naira, a figure beyond the reach of many households. “Even when couples are able to afford an initial cycle, a failed attempt often makes subsequent treatment financially impossible. She said that most people desired IVF but were constrained by affordability, further adding that government subsidy or financial support could significantly increase access to treatment, provided that proper screening mechanisms were put in place to ensure that assistance reached those who genuinely needed it.

She also raised ethical concerns around sperm offers, egg donation, and surrogacy. According to her, donor-assisted reproduction raises questions of identity for children born through such arrangements, particularly where biological parentage is not clearly disclosed. She warned that such situations could create emotional and psychological complications later in life.

Dr. Ogbode further expressed concern about egg donation practices, noting that egg retrieval is an invasive medical procedure involving hormonal stimulation. She warned that without proper counselling and informed consent, vulnerable women could participate without fully understanding the risks involved. The process may also have medical consequences for donors, including effects on ovarian  function.  She  cautioned  that  inadequate  regulation  could  expose economically disadvantaged women to exploitation under poorly monitored fertility arrangements.

On regulation, she observed that Nigeria’s fertility sector still operates with limited legal oversight. For her, legislative efforts to regulate assisted reproductive technologies have progressed slowly, leaving gaps in policy implementation and enforcement. This creates room for unethical practices and weak patient protection mechanisms.

She stressed that policy development in this area must consider the sensitivity and complexity of assisted reproduction. She added that effective regulation should balance medical practice, ethical concerns and the rights of all parties involved, including children born through such procedures.

Dr. Ogbode, also identified weak patient education as a major gap in Nigeria’s fertility care system. She said some patients move directly to in vitro fertilisation without first exploring less invasive and more affordable treatment options. “Fertility care should begin with proper assessment, counselling, and transparency about success rates and alternatives”, she added.

She explained that in some cases, simpler medical interventions may improve reproductive outcomes before resorting to assisted reproductive technologies. She warned that IVF should not be presented as the first line of treatment.

As part of recommended reforms, she called for strengthened fertility education, including  awareness  programmes  for  intending  couples,  particularly  duringmarriage counselling. She also advocated government support for fertility treatment, but insisted that any subsidy scheme must include strict screening to ensure that only eligible couples benefit.

Dr. Ogbode concluded that improving fertility care in Nigeria required a combination of education, ethical medical practice and carefully designed public policy that prioritised both access and patient protection.

 

Beyond the Medical Diagnosis: What Fertility Specialists See

Dr. Chinonye Otuka Tobias Eze, a minimally invasive surgeon, gynaecologist in training and fertility specialist, described infertility as one of the most significant reproductive health challenges facing Nigeria and the wider sub-Saharan African region.

According to her, available studies suggest that between 15 and 25 per cent of couples may experience infertility during their reproductive years, with secondary infertility being particularly prevalent within the region. She challenged one of the most persistent misconceptions surrounding infertility, namely the tendency to place responsibility solely on women. “One important message is that infertility is not exclusively a female problem. Male-factor infertility contributes significantly and therefore both partners should undergo evaluation,” she said.

Providing a breakdown of infertility causes, Dr. Eze explained that female factors accounted for approximately 35 to 40 per cent of cases, while male factors contributed between 30 and 40 per cent. Combined male and female factors represented about 20 per cent of cases, while between 10 and 15 per cent remained unexplained despite medical investigations.

Speaking on fertility treatment outcomes, she noted that IVF success rates vary considerably across centres and patient populations. Success rates per treatment cycle generally range between 30 and 55 per cent, with women below the age of 35 typically recording the highest success rates. She explained that success rates decline significantly after the age of 40 because of reductions in both egg quantity and quality.

“IVF, is a medical process that helps people who are struggling to have a baby naturally. In simple terms, doctors first give the woman medication to help her produce several mature eggs instead of the single egg normally released each month. The eggs are then collected in a minor medical procedure and combined with the man’s sperm in a laboratory to allow fertilisation to take place. If healthy embryos develop, one or sometimes two are carefully transferred into the womb with the hope that one will implant, grow and result in a successful pregnancy. Any remaining healthy embryos may be frozen for future use if needed”, she explained

Dr. Eze  identified several medical factors that influence IVF outcomes, including female age, ovarian reserve, endometriosis (a chronic, painful condition affecting approximately 1 in 10, that is; 190 million reproduction-aged women and gender diverse individuals globally), tubal diseases such as hydrosalpinx (collection of fluid in the fallopian tubes), uterine abnormalities including intrauterine adhesions, submucous fibroids and polyps, as well as male-factor infertility, She further highlighted biological factors such as embryo quality, genetic abnormalities, and endometrial receptivity (within the uterus), alongside lifestyle factors including  obesity, smoking, excessive alcohol consumption, poor nutrition, stress and delayed presentation for treatment.

On the financial burden of fertility treatment, she described affordability as one of the greatest barriers facing couples seeking reproductive care in Nigeria. According to her, ovulation induction procedures may cost between ₦50,000 and ₦500,000, while intrauterine insemination (deposition of semen) ranges from approximately ₦300,000 to ₦1 million. IVF cycles may cost between ₦2.5 million and ₦8 million, while IVF combined with Intracytoplasmic Sperm Injection (ICSI) can range from ₦3 million to ₦10 million or more. Surrogacy arrangements, she added, may exceed ₦10 million to ₦40 million depending on individual circumstances.

“Financial constraints remain the greatest obstacles to treatment access. Many couples delay treatment, discontinue care, or are unable to attempt multiple IVF cycles because of cost. Unfortunately, fertility treatment is rarely covered by health insurance in Nigeria,” she said. Beyond cost, Dr. Eze observed that deeply rooted religious, cultural, and social beliefs continue to shape how infertility is perceived and managed. “Yes, very frequently,” she said when asked the extent to which faith and cultural beliefs influence fertility decisions.

According to her, many couples spend years pursuing non-medical solutions before eventually consulting fertility specialists. She identified common challenges including the stigmatisation of women, and family pressure, to conceiving quickly, misconceptions  about  IVF, concerns  surrounding  embryo handling, opposition to donor fertilised cells and reservations regarding surrogacy.

Recalling some of the beliefs expressed by patients, she said, “A patient once told me that infertility does not run in their lineage. “She also mentioned another encounter that illustrates the extent to which infertility is often viewed through spiritual rather than medical lenses. “Another female patient told me that a prophet told her that the reason the husband’s sperm is bad was that the mother locked it somewhere. According to her, such beliefs frequently contributed to delayed medical intervention. “Many patients present late because they initially believed fertility challenges were solely spiritual rather than medical conditions requiring evaluation and treatment.”

Lived Experience: When Faith is Tested – A Pastor’s 25-Year Fertility Journey

Beyond denominational doctrines and theological interpretations, lived experiences often reveal the deeply personal struggles that exist beneath public conversations about infertility. One such experience comes from Dr. Sylvanus Ukafia, founder of Insight Bible Church, whose journey through infertility spanned twenty-five years and brought him face to face with the emotional, spiritual, and medical realities encountered by many couples seeking children.

Speaking with this reporter, Dr. Ukafia disclosed that he and his wife endured decades of waiting, prayer, and repeated medical interventions before eventually becoming parents. During that period, they sought help from fertility specialists both within Nigeria and abroad, undergoing several assisted reproductive procedures, including in vitro fertilisation (IVF), without immediate success.

According to him, the prolonged wait tested not only their faith but also their emotional resilience. Despite being a medical doctor and a pastor who had prayed for countless families, he found himself confronting the same uncertainties and disappointments experienced by many couples struggling with infertility. “I have prayed for many people. Anybody who is anybody in the gospel has prayed for me. We have done IVF abroad and locally and it has failed. So there is nothing you are going through that we have not gone through,” he said.

Throughout the journey, he continued to support other families facing similar challenges. He revealed that he had helped more than twenty couples access fertility treatments, partly out of compassion and partly in the hope that their testimonies would strengthen his own faith. “I have paid and seen over twenty families have children. I did this so that by paying for their bills and getting them treated, God might have mercy,” he recalled.

He also spoke of the crucial support he received from family members, friends and fellow believers during the difficult years. He recalled how his father consistently prayed that he would one day have children who would care for him as faithfully as he cared for his own parents. Friends also provided financial assistance for fertility treatments, while the success stories of other couples gave him hope to continue.

The medical doctor particularly acknowledged a close friend who became one of his strongest sources of encouragement during the journey. According to Dr Ukafia, the friend consistently urged him not to give up despite repeated disappointments and financed a final IVF cycle.

Eventually, after years of disappointment and waiting, the family welcomed a daughter through circumstances he preferred to keep private. He described her arrival as a turning point that renewed hope within the family and strengthened their resolve to continue pursuing medical treatment. Several years later, that perseverance yielded another breakthrough. In 2015, the couple welcomed twin children conceived through IVF, bringing to fruition a journey that had stretched into more than two decades.

Reflecting on the experience, he said some people questioned why a preacher known for teaching faith would seek medical assistance. However, he rejected the notion that fertility treatment and faith are incompatible. “When we finally succeeded, my friend who had been speaking to me began to abuse me. He said, ‘You are a preacher of faith.’ And I said, ‘I have enough results in every other thing. I do not say prayers that state there is shame. No, there is absolutely no shame in anything. What God has not done is a matter of time. He will do it.'”

As a medical doctor and a pastor, Dr. Ukafia said his understanding of fertility treatment helped him navigate many of the ethical and practical questions that couples often face. He noted that while fertility treatments can be expensive, more affordable options now exist than many people realise.

His story illustrates the complex intersection of faith, medicine, and human deprivation. It demonstrates that infertility can affect anyone regardless of social standing, profession or spiritual position; and highlights how many couples continue to rely on a combination of medical care, community support, and faith while navigating one of life’s most challenging experiences.

For many Nigerians struggling with infertility, Dr Ukafia’s testimony serves as a reminder that seeking medical intervention does not necessarily diminish faith. Rather, for some families, faith and science can work side by side in the long journey towards parenthood.

Coming in Part 2: Why do some churches embrace assisted reproductive technologies while others oppose them? The next part of this investigation examines what the Presbyterian, Apostolic and Catholic churches teach about IVF, surrogacy and infertility, and how those beliefs shape the decisions of many Nigerian Christian couples.