Perceptions of Couples and Healthcare Providers on the Cost of Fertility Treatment: A Mixed-Methods Study from Two Tertiary Facilities in Rivers State, Nigeria

Abstract

Background: High fertility treatment costs remain a major barrier to accessing reproductive healthcare in low- and middle-income countries such as Nigeria. Understanding the perceptions of couples and healthcare providers regarding these costs is important for developing equitable fertility care policies.

Objectives: This study examined perceptions of couples and healthcare providers on the cost of fertility treatment, its influence on access and decision-making, and factors contributing to high treatment costs in two tertiary fertility facilities in Rivers State, Nigeria.

Methods: A descriptive cross-sectional mixed-methods design was adopted. Data were collected from 276 respondents using structured questionnaires administered at the University of Port Harcourt Teaching Hospital (UPTH) and Noble Medical Consultants and Fertility Hospital (NMCFH) between November 2025 and March 2026. Six purposively selected participants participated in in-depth interviews. Quantitative data were analysed using descriptive statistics, while qualitative data were analysed thematically.

Results: Couples perceived fertility treatment as largely unaffordable, with medication expenses, repeated treatment cycles, and out-of-pocket payments identified as major financial burdens (mean ≥ 3.8). High costs discouraged treatment continuation, delayed care-seeking, and limited access to quality services. Healthcare providers agreed that treatment costs exceeded patients’ income levels and contributed to poor treatment compliance, delayed presentation, and discontinuation of care. Major cost drivers included fertility drugs, diagnostic tests, IVF and ICSI procedures, inflation, exchange rate fluctuations, and dependence on imported equipment.

Conclusions: Financial barriers significantly limit access to fertility treatment in Rivers State, Nigeria. Subsidised fertility services, insurance coverage for assisted reproductive technologies, and local production of consumables are recommended to improve affordability and equitable access.