ORIGINAL RESEARCH ARTICLE AWARENESS REGARDING INFERTILITY AMONG WOMEN ATTENDING CHITWAN FERTILITY CENTER

Background : Infertility is a condition where couple failure to conceive after 1 year of regu - lar unprotected coitus. At least 50 million couples worldwide experience infertility. Several adverse consequences of infertility like tension, hostility, anxiety, depression, self-blame and suicidal ideation are now being increasingly recognized. This study was designed to assess the awareness regarding infertility among women attending Chitwan Fertility Center. Methods: A cross sectional analytical study design was used and population for study includes those married women who had failure to conceive and visited to Chitwan infertility centre. The data was collected through semi-structured interview schedule. Collected data was coded and entered and analyzed in Microsoft office Excels and SPSS 20 version by using descriptive and in ferential statistics. Results: In present study, among 96 respondents, majority of the respondents 45.8% were from age group of 25-30 years. Most of the respondents 56.3% had completed bachelor level and above level education. Majority of women 87.5% had good awareness on infertility. There was no signifi - cant association between level of awareness and socio-demographic variables. Conclusions: It can be concluded that the awareness about infertility among the participants at - tending Chitwan fertility center is relatively good. Most of the participants were educated, dura tion of marriage was also 5-10years and most of them came to the infertility center for the treat - ment and management of infertility that might be the reason they have good awareness regarding infertility. But there is still misconception in some of the participants.


INTRODUCTION
Parenthood is a fundamental human need. Every human being has a desire to become a parent and look after his or her children fertility or the ability to produce children has a positive social value. 1 Worldwide, 48.5 million couples are unable to have a child, of which 19.2 million couples are unable to have a first child, and 29.3 million couples are unable to have an additional. 2 An increasing trend of infertility in South Asia, 6% has been noticed recently in Nepal this prevalence is higher than (4%) Bangladesh and (5%) Pakistan. 3 The total fertility rate has declined markedly in Nepal over time. The fertility decline in female already starts around 25-30 years of age. 4,5 In any given month; couple has a 20% chance of conceiving. In a lifetime, 10-15% of couples will experience infertility. This number increases to 33% than the womens age is above 35 years. In about 45% of cases there is a male-origin for the infertility, female-origin infertility accounts for 30% of cases, and in 20%, both partners are the source of difficulties. 6 Due to infertility several adverse consequences occur in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation too. 7 Very few studies have been conducted awareness in infertility. It is important to examine the awareness to see to what extent there may be room for improvement in the light of current knowledge.
The study was aimed to assess the awareness regarding infertility among women attending Chitwan Fertility Center.

METHODS
A cross sectional analytical study design was adopted with the aim to assess the awareness regarding infertility among women. The data was collected in Chitwan Fertility Center of Bharatpur 10, from Jun 22 to July 4 ,2019. The study population included married women who had failure to conceive after one year of regular unprotected coitus. Non probability purposive sampling technique was used to select samples. Calculated sample size was 96. The questionnaire was developed by the researcher based on extensive literature review and consultation with subject expert. A semi-structured interview schedule was used as data collection tool. It consisted of two parts; part I was related to socio-demographic variables and Part II contained questions related to awareness. These questions were answered on a Yes/No basis with an additional "I don't know" option. A correct answer was assigned 1 point and an incorrect/unknown answer was assigned 0 points. The total knowledge score ranged from 0 to 24, with a higher score denoting a better awareness of infertility. Prior to data collection ethical approval was obtained from the Institutional Review Committee SMTC-IRC-20190524-62. The principal investigator collected the data through interview method after taken written consent. Collected data was entered in excel, analyzed in SPSS 20 version and interpreted by using descriptive statistics (frequency percentage) and inferential statistics (chi-square). The major problems faced by infertile women were remarriage 80 (83.3%) and rejection from society 79 (82.3), The source of information for most of the respondents were health personnel 85.4% and newspaper 76% ( Table 2).  Table 3 showed that most of the respondent 87.50% had good awareness on infertility and 12.50% had poor level with mean score 21.2813 ±SD2.05556 awareness on infertility.     (Table 5). Table 6 showed that there was no statistically significant association between level of awareness and socio-demographic variables.

DISCUSSION
In this study awareness on infertility was assessed among married women and found mostly adequate. Out of 96 respondents, majority 87.50% had good awareness, 12.50% had poor awareness. This finding is comparable with the findings of the study conducted by Kaur et al. 1 where 79% had good knowl-edge 15% had poor knowledge. However, the good awareness is not the only factor for better practices and prevention. Increasing the level of awareness may help to decrease the incidence of infertility by allowing couples to avoid certain risk factors that might lead to it.
To be able to achieve the desired number of children by spontaneous conception, couples should try to conceive no later than at the age of 32 years for a one-child family, at 27 years for a two-child family, and at 23 years for three children. 8 In present study, 45.8% of the respondents were in the age group of 25-30 years and 43.8% of the respondents have marriage duration of 5-10 year. Similar findings were found in the study of Dattijo et al. 9 Numerous factors such as age and duration of marriage have been associated with reduced fertility. 7 The fertility decline in female already starts around 25-30 years of age.⁴ The risk factors for infertility include age, smoking, obesity, alcohol consumption menstrual cycle and current lifestyle This study identified that, women 70.80%, were commonly blamed for the infertility problem. This finding is supported by the study of Dattijo et al. 9 where 73.60% respondents said wife are commonly blamed for the infertility problem. Infertility is not merely the health problem; it is also a matter of social in justice and inequality. It is also complicated marital dynamics, some time leading to marital inability and occasionally divorce, polygamy or remarriage because motherhood is considered a mandatory status, infertile women may be harassed and tormented. Women for often blamed for the infertility and men engaged in polygamy in an attempt to have children. 11 Awareness may also help wider society to understand and empathize with the infertile couple, which may lead to a decrease in the psychological burden to those affected. 10 The source of information, 85.4% of the respondents had selected health personnel which contracts the similar study by Kaur et al. 1 where 64% had selected friend as their source of information. In this study most of the respondents have 5 to 10 years of married durations and were in the regular check up with health personnel that might be the reason to select health personnel as a source person.
The present study showed that, majority of respondents 66.70% stated the correct definition of infertility, regarding the ovulation occurrence period, 63.5% knows the time of ovulation occurrence, 86.5% of respondents knew the meaning of conception as union of ovum and sperm this finding is contracts with the study conducted by Ali, et al. 7 where only 36% choose the correct option. Only 32% were able to give the correct meaning of conception. In this study most of the respondents were educated bachelor and above.
Several studies have noted noxious effects of tobacco before and after conception, in both women and men, from the smokers' gametes to their offspring. 12 In this study finding, regarding risk of male infertility, 96.9% of the women take smoking as the main risk of male infertility while 84.4% said alcohol, 77.1% choose working in hot environment, 62.5% choose STIs and only 57.3% choose wearing tight panty/pants as risk of male infertility. The first place for treatment of infertility problem, most of the respondents 95.8% preferred hospital which contrasts the study of Dattijo et al. 9 where 42.10% of respondents choose traditional healer and only 28.3% preferred hospital for treatment. This might be due to most of the respondents of this study were aware, educated and on regular checkup with health personnel.
The study population was small and conducted in Fertility Centre Chitwan Bharatpur only, hence the study findings cannot be generalized.