Exploring Undergraduates' Knowledge, Attitude, and Perception of Infertility in Osun State University: A mixed method study

This mixed-method study of 300 undergraduates at Osun State University reveals that students possess low knowledge and predominantly negative attitudes toward male infertility, which are significantly influenced by academic level, faculty, and formal education, highlighting the urgent need for gender-inclusive health education to address cultural misconceptions.

The Gist

Imagine a university campus as a giant, bustling marketplace where young people are getting ready to start their own families. In this marketplace, there is a very important, but often ignored, shop called "The Male Fertility Shop."

This research paper is like a group of investigators walking through that marketplace to ask the students: "Do you know what's in this shop? Do you think it's broken? And would you be scared to walk inside?"

Here is the story of what they found, explained simply:

1. The Big Misunderstanding (The "Female Problem" Myth)

For a long time, people thought infertility was like a broken engine in a car that only happened to the driver (the woman). If a couple couldn't have a baby, everyone blamed the woman.

The Reality Check: The researchers found out that the engine can break in the car itself (the man) just as often! In fact, about half of all infertility cases involve the man. But because of old stories and cultural rules, men are often too shy to talk about it or go to the doctor. It's like having a flat tire but being too embarrassed to admit the car has a problem, so you just keep driving until you break down.

2. What the Students Knew (The "Textbook vs. Reality" Gap)

The researchers asked 300 students at Osun State University what they knew.

• The Good News: Most students knew that infertility is a medical condition, not a curse from the gods. They knew it could be treated with medicine or surgery, just like fixing a broken leg.
• The Bad News: Their knowledge was "surface level." It was like knowing a car needs gas but not knowing how the engine works. Only about half of the students had a "good" understanding of the details.
• The Education Factor: Students who had taken specific classes on this topic knew much more. It's like the difference between someone who just watches car commercials and a certified mechanic. The mechanic (the educated student) knew the truth; the casual viewer was guessing.

3. How They Felt (The "Masculinity" Trap)

This is where it gets tricky. Even though the students knew intellectually that men can be infertile, their feelings were still stuck in the past.

• The "Manhood" Test: Many students still felt that if a man couldn't have a baby, it was a blow to his "manliness." It's like society telling a man, "If you can't build a house, you aren't a real builder."
• The Dating Dilemma: When asked, "Would you marry someone who can't have kids?" many students said No. Even though they knew it was a medical issue, the social pressure was so strong that they didn't want to be associated with it.
• The Silence: The students agreed that talking about male infertility in Nigeria is like whispering a secret in a crowded room. It's a taboo. People are afraid of being judged by their family or friends, so they stay silent.

4. The Roadblocks (Why Men Don't Go to the Doctor)

The researchers asked, "What stops men from getting help?" The answers were like a wall of barriers:

• Stigma: The fear of being laughed at.
• Cost: It's expensive to fix the "engine."
• Religion & Culture: Some people think it's a spiritual problem that needs a prayer, not a doctor.
• The "Witch" Blame: Even when men know the truth, society often still points the finger at the woman, calling her a "witch" or blaming her, while ignoring the man's role.

5. The Solution (The "Fix-It" Plan)

The students themselves had great ideas on how to fix this mess:

• Talk More: We need to stop whispering and start shouting about this. Schools should teach it, just like they teach math or history.
• Check-Ups: Before a couple gets married, they should both get a health check-up, like a pre-flight safety check for a plane.
• Celebrate Awareness: Just like we have days for cancer or mental health, we need a "Male Infertility Day" to break the silence.

The Bottom Line

This study is a wake-up call. It tells us that while Nigerian university students are smart enough to understand the science of male infertility, they are still trapped by the stories society tells them about what it means to be a man.

To fix the problem, we need to change the story. We need to tell men and women that infertility is a shared journey, not a secret shame. If we can open the door to the "Male Fertility Shop" and let people walk in without fear, we can help more families start their lives together.

Technical Summary

1. Problem Statement

Infertility is conventionally perceived in many cultures, particularly in Nigeria, as a female-centric issue. This misconception leads to the underrepresentation of male infertility in healthcare discussions, significant stigma, delayed diagnosis, and psychological distress for affected men. Despite a high burden of male infertility in Nigeria (with studies showing ~84% of men in fertility clinics having seminal fluid abnormalities), there is a lack of empirical data regarding the awareness, knowledge, and perceptions of this condition among Nigerian undergraduates—a demographic on the cusp of making reproductive decisions. This study aims to fill this gap by assessing the knowledge, attitude, and perception of male infertility among students at Osun State University (UNIOSUN).

2. Methodology

The study employed a convergent parallel mixed-methods design (quantitative and qualitative) conducted at Osun State University, Nigeria, between June and July 2025.

• Study Population & Sampling:
  • Target: Registered undergraduates.
  • Sampling: Multistage sampling with a final sample size of 300 respondents (after exclusions from an initial 333).
  • Demographics: Predominantly female (64.0%), Health Sciences faculty (96.7%), and single (96.3%). Mean age was 20.99 ± 2.31 years.
• Data Collection:
  • Quantitative: Self-administered structured questionnaires assessing socio-demographics, knowledge (4 items, max score 10), attitude (4 items, max score 4), and perception. Scores $\ge$8 indicated "good knowledge," and $\ge$2 indicated "positive attitude."
  • Qualitative: Four Focus Group Discussions (FGDs) with 8–10 participants each, using semi-structured guides. Sessions were audio-recorded and transcribed verbatim.
• Data Analysis:
  • Quantitative: Analyzed using IBM SPSS Statistics v27. Descriptive statistics, Chi-square tests, and Binary Logistic Regression were used to determine associations (significance set at $p < 0.05$).
  • Qualitative: Thematic analysis performed using NVivo software.

3. Key Results

Quantitative Findings

• Knowledge: Overall knowledge was low (47.7%). While 86.0% believed male infertility is treatable, specific medical knowledge was insufficient.
• Attitude: More than half of the respondents held a negative attitude (52.3%) toward male infertility.
• Perception:
  • 86.0% identified stigma and cultural beliefs as major barriers to treatment.
  • 86.3% cited lack of awareness as a barrier.
  • 73.7% believed male infertility is not widely discussed in Nigeria.
• Statistical Associations:
  • Knowledge: No socio-demographic variable (gender, age, faculty, level, marital status, prior education) showed a statistically significant association with knowledge levels in the regression analysis.
  • Attitude: Significant predictors of a positive attitude included:
    • Faculty: Health Sciences students had significantly more positive attitudes than others ($p=0.009$).
    • Level of Study: 400-level students had the most positive attitudes ($p=0.031$).
    • Formal Education: Students who had received formal education on male infertility were significantly more likely to have positive attitudes ($p=0.007$).

Qualitative Findings (Thematic Analysis)

• Knowledge: Participants defined infertility functionally (inability to impregnate after 12 months) and identified causes ranging from medical (STIs, low sperm count) to lifestyle (smoking, alcohol). There was skepticism regarding the efficacy of traditional herbs.
• Attitude:
  • Gender Bias: While students intellectually rejected the idea that infertility is solely a female issue, deep-seated biases remained. Many expressed reluctance to marry a man with infertility.
  • Masculinity: Opinions were divided on whether infertility diminishes masculinity; some linked it to low self-esteem, while others maintained it does not define manhood.
  • Help-Seeking: Despite stigma, there was strong consensus that men should seek medical help.
• Perception & Barriers:
  • Taboo: Male infertility is a "silenced" topic.
  • Blame: A recurring theme was the tendency to blame women (e.g., calling them "witches") even when male factors are acknowledged.
  • Recommendations: Participants suggested health education, awareness campaigns, institutionalizing pre-marital screening (sperm counts), and creating specific commemorative days for male infertility.

4. Key Contributions

• Mixed-Methods Insight: The study uniquely combines statistical prevalence with qualitative depth, revealing that while students possess some biological knowledge, their attitudes are heavily constrained by cultural norms and gender roles.
• Identification of the "Education Gap": The study demonstrates that formal education is a critical predictor of positive attitudes, suggesting that current curricula (even in health sciences) may be insufficient in addressing the psychosocial aspects of male infertility.
• Documentation of the "Paradox": It highlights a societal paradox where students intellectually acknowledge male infertility as a medical condition but socially stigmatize it, often reverting to blaming women.

5. Significance and Implications

• Public Health Policy: The findings underscore the urgent need to integrate comprehensive, gender-inclusive reproductive health education into university curricula across all faculties, not just health sciences.
• Stigma Reduction: Interventions must address the "silence" surrounding male infertility. The study suggests that awareness campaigns and pre-marital screening protocols could normalize the issue and reduce diagnostic delays.
• Future Research: The study highlights the need for broader research beyond health science students to understand the general population's perception, as the current sample may have overestimated knowledge levels.
• Clinical Practice: Healthcare providers in Nigeria must anticipate and address the psychological distress and social marginalization men face, moving beyond a purely biological treatment model to a holistic care approach.

Conclusion: The study concludes that while undergraduates at UNIOSUN have a foundational understanding of male infertility, their attitudes remain negatively influenced by cultural stigma and gender bias. Targeted educational interventions and policy changes are essential to foster open dialogue and improve reproductive health outcomes.