If women do not fall pregnant within a year or more of marriage, they are often stigmatised and regarded as worthless by their husband’s – and even their own – families.

But, although more women suffer from infertility, many men also have faulty reproductive systems.

Abbaram Sani, who is in charge of family planning at the Yerwa Maternal Health Clinic in Maiduguri, said it was not fair that infertile women were stigmatised.

“You often hear that so and so have been married for four or five years but they still have not have children birth. And it is usually the man’s family who insult and blame the wife. They do this even though neither the husband nor the wife have been examined at a fertility clinic or by a doctor. And there is always the possibility that the man’s reproductive system is the cause of the infertility.”

She said she knew of some cases when the husband’s parents had asked him to marry someone else because his wife had not conceived. It was beyond their comprehension that it might be their son who was infertile.

Sani said there were many causes of infertility, including excessive intake of alcohol, which could result in both genders being infertile.

The World Health Organisation (WHO) said in the male reproductive system, infertility was most commonly caused by problems in the ejection of semen, absence or low levels of sperm, or abnormal shape (morphology) and movement (motility) of the sperm.

In the female reproductive system, infertility might be caused by a range of abnormalities of the ovaries, uterus, fallopian tubes and the endocrine system, among others.

It said other environmental and lifestyle factors such as smoking and obesity could affect fertility and exposure to environmental pollutants and toxins could damage gametes (eggs and sperm), resulting in decreased numbers and poor quality.

“Some men are naturally infertile but their family members do not realise that and they blame the women,” Sani said.

“Most people who have been married for years without having children believe that it is Allah who will bless them with children when the time is right,” Sani said. “But Allah has asked us to seek medication when we are sick. So it follows that couples who do not conceive easily should go to a doctor to check whether either partner is infertile.”

Sani said: “Don’t just sit at home and blame yourselves for infertility in the marriage. Seek help.”

She said that most women did not know that infections could lead to infertility. They might be embarrassed about having an infection, such as bacterial vaginosis, pelvic inflammatory disease and endometritis – all infections of the genital tract that could lead to many adverse health outcomes, including infertility.

“Often, because they are embarrassed, they remain silent and do not go to a doctor or hospital. And they do not know that these infections could result in not being able to conceive. If more couples sought help, they could conceive and be blessed with children,” Sani said.

The WHO said infertility was a disease of the male or female reproductive system defined by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse.

The Office on Women’s Health (OASH) said the most common causes of infertility – apart from excessive alcohol use and smoking – included age, stress, a poor diet, athletic training, being overweight or underweight, sexually transmitted infections (STIs) and health problems that caused hormonal changes.

It said Infertility could be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Often these treatments were combined. In most cases infertility was treated with drugs or surgery.

The WHO said the availability, access and quality of interventions to address infertility remained a challenge. Diagnosis and treatment of infertility was often not prioritised in national population and development policies and reproductive health strategies and were rarely covered through public health financing.

A lack of trained personnel and the necessary equipment and infrastructure, as well as the high costs of treatment medicines, were major barriers.

To effectively address infertility, health policies need to recognise that infertility was a disease that could often be prevented, thereby mitigating the need for costly and poorly accessible treatments, the WHO said.