Pa ge 1 Pa ge 33 American Journal of Life Science and Innovation (AJLSI) Impact of SDG3 in the Prevention of Physical and Mental Effects of Infertility Observed in Nigerian Women: A Scoping Review Tayyibat Ayoola Egbewole1, Ncube F.1, Aloysius Obinna Ikwuka2* Volume 3 Issue 2, Year 2024 ISSN: 2833-1397 (Online) DOI: https://doi.org/10.54536/ajlsi.v3i2.3139 https://journals.e-palli.com/home/index.php/ajlsi Article Information ABSTRACT Received: June 27, 2024 Accepted: July 31, 2024 Published: August 03, 2024 Infertility significantly impacts both the physical and emotional well-being of individuals and is particularly prevalent in low- and middle-income countries like Nigeria. Since many causes of infertility are avoidable, there is potential for public health initiatives and Sustainable Development Goal 3 (SDG3) to play a role in health education and prevention. This scoping review aimed to assess existing literature for a better understanding of the factors relevant to analyzing how SDG3 might influence Nigerian women’s ability to mitigate the physical and mental effects of infertility. Exhaustive searches were conducted across electronic databases including Scopus, Web of Science, JSTOR, CINAHL, MEDLINE, and PubMed. The initial review commenced in October 2023, with the final search concluded in March 2024. Identified papers underwent screening using the PRISMA extension for scoping review flow diagrams. After removing duplicates and screening titles and abstracts, 1,340 papers were identified, with 169 reports evaluated for inclusion. Ultimately, 46 papers met the inclusion criteria for this scoping review. Data analysis revealed various factors contributing to the burden of infertility among Nigerian women, encompassing medical conditions, modifiable risk factors, environmental influences, physical and psychological stressors, and policy- related considerations. Socio-economic factors were also implicated in infertility within this population. However, significant gaps in knowledge persist, as no substantial findings were uncovered regarding the true causes across these categories. Therefore, addressing the burden of infertility among Nigerian women requires a multi-faceted approach including interventions aligned with SDG3, public awareness campaigns, health screening initiatives, utilization of assisted reproductive technologies, provision of physical and psychological wellness services, as well as counseling support. Keywords Impact, Sustainable Development Goal 3, SDG3, Prevention, Physical Effects, Mental Effects, Infertility, Nigeria, Women, Scoping Review INTRODUCTION The United Nations implemented Quality Health and Wellness as one of the 17 Sustainable Development Goals in 2015, intending to guarantee robust livelihoods and advocate wellness for all, regardless of age (United Nations, 2015). Sustainable Development Targets emphasize living a healthy lifestyle, with indicators tracking progress across countries (Ritchie, 2018). SDG3 comprises thirteen targets and twenty-eight indicators to monitor progress. These targets focus on reducing maternal and child mortality, combating diseases, enhancing psychological well-being, deterring substance misuse, diminishing road-related accidents, and granting widespread entry to medical care and birth control. SDG3 additionally strives to attain comprehensive health protection and impartial entry to medical care for all sexes, which endeavors to guarantee communal availability of family planning as well as sexual and reproductive health amenities (United Nations, 2017). Several studies have explored the frequency of infertility in underdeveloped and developing countries, such as Nigeria, and its potential impacts on the physical and mental wellness of affected individuals. Gametes are ova and sperm cells that are haploid and have one copy of each type of chromosome i.e. 1–22 X or 1–22 Y (Ikwuka, 2023a). The World Health Organization (WHO) defines clinical infertility “as the inability to give birth to a healthy baby after at least one year of regular, unprotected sexual activity” (WHO, 2020). Estimates vary, suggesting that globally, between 48.5 million and 186 million couples may be affected by primary or secondary infertility (Starrs, 2018), depending on the measurement method (Inhorn, 2015; Mascarenhas, 2012). Primary infertility refers to the inability to conceive or start the development of a child. One significant factor contributing to secondary infertility is infections of the reproductive tract (Kaufman, 1999), which are more prevalent than primary infertility (Starrs, 2018) and describes the inability to become pregnant even after previous attempts (Bowa, 2012). Autoimmune antibodies produced by the female partner against sperm cells from the male partner have been implicated as a cause of female infertility. Other immune reactions include antibodies to clotting factors, which result in both thrombosis and hemorrhage; and hemolytic reactions during transfusion of blood products (Ikwuka, 2023e). Oxidative stress has also been associated with infertility. Linked to the induction of oxidative stress are major free radicals. Among these major free radicals, superoxide anions, hydroxyl radicals, and hydroperoxyl radicals are of physiological significance. A non-radical of physiological significance is hydrogen peroxide (Ama, 1 Faculty of Health/Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom 2 College of Medicine and Health Sciences, American International University West Africa, Banjul, The Gambia * Corresponding author’s e-mail: aloysiussweet@yahoo.com Pa ge 34 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 2023; Baysah, 2023; Ekechi, 2023a; Ikwuka, 2023b). The influence and effects of hormonal imbalance in females leading to infertility in such females have also been reported in different studies (Aliu-Ayo, 2023a; Aliu-Ayo, 2023b). Parenthood is often socially and culturally expected in many societies, and infertility’s physical and psychological effects on individuals’ well-being and health have been extensively researched in underdeveloped and developing countries (Nahar, 2022). Many forms of stigmatization are experienced by those who do not fulfil the societal norm which demands having offspring. This can result in stress, unstable marriages, verbal abuse, violence against partners, separation, and exclusion. A thorough definition of fertility awareness considers behaviorally influencing variables at every stage of life, such as cognitive, social, environmental, and developmental aspects (McCurdy, 2015). It is widely acknowledged that a lack of knowledge about fertility hurts views and actions concerning sexual and reproductive health (SRH) throughout the course of one’s life. These behaviors include not using family planning (FP) methods, delaying the application of FP methods after giving birth or after an abortion, stopping the use of FP methods, using ineffective FP methods, getting pregnant unintentionally, and having false beliefs about being infertile (Dyer, 2002). Diabetes mellitus and arterial hypertension remain two of the most common diseases in the world. Today, diabetes mellitus (DM) ranks third in the overall structure of morbidity and mortality after cardiovascular diseases and oncological diseases (Virstyuk, 2021a). In addition, the interplay, role and effects of metabolic syndrome diseases on male fertility are still being investigated by different researchers. Metabolic disorders, e.g. Hypertension, Adiposity, Diabetes mellitus and Dyslipidemia, collectively known as Metabolic Syndrome Diseases (MSDs) are diseases related to one another (Ikwuka, 2015; Ikwuka, 2017a; Ikwuka, 2017c; Ikwuka, 2023c; Ikwuka, 2023f; Ikwuka, 2024; Virstyuk, 2016). Different studies have shown that MSDs are associated with asymptomatic hyperuricemia, systemic immune inflammatory processes, and fibrogenesis all of which can lead to nephropathy (Ikwuka, 2017d; Ikwuka, 2017e; Ikwuka, 2018c; Ikwuka, 2018d; Ikwuka, 2019a; Ikwuka, 2019c; Ikwuka, 2022; Ikwuka, 2023d; Virstyuk, 2017a; Virstyuk, 2018a; Virstyuk, 2019; Virstyuk, 2021a; Virstyuk, 2021b). Governments and sexual reproductive health right (SRHR) organizations still overlook infertility despite several other delicate SRHR issues being addressed, including abortion, teenage SRHR, and comprehensive sexuality education (Ombelet, 2011). Inaccurate prevalence numbers on infertility contribute to its invisibility and undermine justifications for action, including offering complete reproductive care, preventing and de-stigmatizing infertility-related disorders (Ombelet, 2011). Furthermore, little is known about current initiatives to address infertility in nations with low and moderate incomes, such as Nigeria (Kroes, 2019). Men’s involvement in infertility management and counseling is encouraged by the availability of assisted reproductive technologies (ARTs), which also improve gender relations and raises awareness of female infertility (Inhorn, 2015). However, the greatest obstacle to expanding access to ARTs in nations like Nigeria will continue to be the high cost of these treatments (Starrs, 2018). Many couples wait until they need treatment. As a result, additional initiatives are required to lessen the stigma associated with infertility and the detrimental consequences it has on the lives of those who are struggling with it. Since avoidable factors account for a large share of infertility; public health, and sustainable development can contribute to reduce the burden (Van der Poel, 2012). With over 220 million inhabitants, Nigeria is the most populous country in Africa. There has yet to be evidence that the nation’s 2.5% annual population growth is causing its financial and socio-economic needs, particularly in healthcare, to rise quickly (World Bank, 2023). From a per capita and state government’s perspective on budget share, the country’s health financing is relatively low. Nigeria’s health sector governance needs to be improved, with institutional channels for advocacy and involvement that need to be improved, contributing to the low coverage of most preventive and curative health treatments. The majority of Nigerians, like those in most developing nations, are pronatalists who favor early marriage and large number of children. As a result, the idea of deliberate childlessness is foreign, and trying to conceal infertility will only make it more stigmatized (Orji, 2008). The perception of a social norm breach may cause the responses to infertility from the extended family or the community. Children are valued greatly in the society, and generally speaking, a woman’s value is based on her capacity for reproduction (Okonofua, 2002). When comparing underdeveloped countries to industrialized countries, the cultural realities of different locations cause unique issues related to infertility. Family planning initiatives are supposed to target over- fertility rather than infertility according to an established argument, given the overpopulation of most developing nations (Runstein, 2004). The high population rise in most emerging countries has led to an expansion of family planning services and population policies. Nevertheless, it appears that supporting infertile females, which is a component of this service, has been overlooked. Infertility is a critical reproductive health concern that can have dramatic repercussions, including suicide, even with the high rate of population expansion (Daar, 2002). Due to inadequate guidelines and insufficient treatment options, infertility is frequently poorly managed medically (Ola, 2008). The organized efforts of society to safeguard, advance, and improve people’s health are referred to as public health. This is a blend of science, abilities, and values aimed at preserving and enhancing everyone’s health through collaborative or social acts. Since families are Pa ge 35 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 the foundation of society and are affected by infertility, the effects are not limited to women. Most developing countries have experienced substantial population decrease with services for contraception and population controls expanded. Infertility has been linked to physical, emotional, and psychological side effects e.g. anxiety, sadness, marital problems, and social stigma, therefore infertility is not just a medical issue (Daar, 2002). Since infertility impacts the entirety of one’s life experience both qualitatively and quantitatively, public health and Sustainable Development Goal 3 have recently emphasized the necessity for an intimate social link between an individual and the environment. It is a societal problem that affects individuals as well as 10% of the people who are of reproductive age experiencing infertility in one way or the other (Evens, 2004). Stress has a depressing influence on various hormones that act in fertility, and infertility can amplify the pain and emotions experienced by those impacted. This may set off a vicious cycle in which stress results in infertility, which in turn causes more stress, which further reduces fertility (Greil, 1997). Due to the perception that infertility is solely a medical condition and the assurances given to patients by medical professionals regarding the minimal impact of stress on ovulation, the psychological and physiological aspects of the condition have been neglected. There are several psychological or mental health effects, including societal ramifications and personal pain, which can hurt infertility. When treatment is accessible, technological developments in assisted reproduction can give many couples hope. Nonetheless, there are obstacles related to pricing and medical coverage. According to (Cousineau, 2007), by medicalizing infertility, women’s emotional reactions, including pain, a loss of control, shame, and a change of course for their adult lives — have unintentionally led to contempt for these feelings. The psychological impact of infertility can be awful. Partners who are more anxious to become pregnant may have worsening sexual difficulties. Couples who are infertile frequently experience marital disagreement, particularly when they are pressured to make medical choices. Similar to those with cancer or heart illness, women who are attempting to conceive frequently experience clinical depression (Domar, 1993). Metabolic syndrome diseases (MSDs) are interrelated diseases with very high economic costs, morbidity, and mortality rates, thus requiring the search for new and effective treatment options (Ikwuka, 2024). Treatment optimization in MSD patients using a combination of HMG-CoA and SGLT-2 inhibitors, and A2RB (AT1) has resultant clinical effectiveness as indicated by marked improvements in metabolic functions of the heart, liver, pancreas, and kidney (Ikwuka, 2017b; Ikwuka, 2018a; Ikwuka, 2018b; Ikwuka, 2021; Virstyuk, 2017b; Virstyuk, 2018b; Virstyuk, 2018c; Ikwuka, 2024). In addition, Glucagon-like Peptide 1 Receptor Agonists (GLP-1 RAs) e.g. Liraglutide have been found to improve the efficacy of treatment and clinical course of type 2 diabetes mellitus and hypertension in patients with such comorbidities (Ikwuka, 2019b). It has also been reported that coconut water has hepatorenal protective functions against alloxan- induced type 1 diabetes mellitus (Ekechi, 2023b). Stress levels are high even for couples using infertility treatments (Beutel, 1999). Infertility can lead to a range of emotional challenges for individuals, including the loss of envisioned life plans and the disappointment of not experiencing motherhood or parenthood as anticipated. It may also trigger feelings of uncertainty about one’s identity, a sense of losing control over life’s circumstances, and strain on relationships, sometimes leading to their breakdown. Additionally, for many individuals, infertility can result in the loss of support from religious communities, which previously provided strength and solace. Couples where the male partner is identified as the source of infertility often face heightened emotional strain and encounter difficulties within their marital relationship. There are 186 million infertile individuals in the globe, with 30 to 40 per cent of them residing in Africa. Based on multiple cultures in Nigeria, a married couple should have a kid during the first few years of their union. When a couple begins to battle with infertility, the question “When do you plan on having children?” may seem lighthearted in the first year of marriage, but it may also be a severe insult (Sharma, 2009). The experiences of childless women in Africa are currently not well documented in a comprehensive qualitative way. These could affect how well infertility is managed with the addition of appropriate medications. Extensive, evidence- based data about the experiences of African and Nigerian infertile women is absent, as previous assessments have concentrated on the clinical or biological models. In a region with such high fecundity, assembling research data on the variety of medical and psychological issues related to infertility requires a rigorous evaluation of the available information. While certain academic studies and medical publications have discussed different facets of infertility in Nigeria (Orji, 2002), further work is required. The primary goal of this literature evaluation is to study and thoroughly record the medical and psychological components of fertility problems among Nigerian women while evaluating its effect concerning the afflicted individuals and their societal context, as well as the role of healthcare professionals’ attitudes in patients’ acceptance of their diagnosis. This study aims to pinpoint areas of deficiency in existing literature concerning the initial research endeavors, healthcare policies, and comprehensive evaluations on this topic as in other related studies (Koster-Oyekan, 1999; Umezulike, 2003). There needs to be more systematic data regarding the psychological, physical, and socio-cultural effects of infertility on the well-being of Nigerian women. This is true, even if primary research studies are expected (Tanywe, 2018). This justifies the requirement for a thorough scoping evaluation of the infertile literature. Pa ge 36 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 This scoping review aims to comprehensively assess the literature and identify key variables relevant to understanding how Sustainable Development Goal 3 could play a role in alleviating the physical, and psychological challenges associated with infertility among Nigerian women. This review will locate, synthesize, and summarize existing research to investigate the elements influencing Nigerian women suffering from both primary and secondary fertility issues regarding their physical and emotional health. By giving a more excellent knowledge of the relationship between the physical and mental repercussions of infertility among women in Nigeria, this study will enable health professionals and society to develop effective measures for the prevention and management of infertility. MATERIALS AND METHODS Study Design This research is a scoping review. Due to the variety of research that has been done on the topic, (Munn, 2018) adopted this design as opposed to doing a systematic review. A scoping assessment was conducted on current interventions aimed at reducing the stigma associated with infertility as well as its psychological and physical repercussions. A description and conceptualization of the impact of sustainable development goals on the physical and psychological repercussions of infertility was carried out before outlining the steps and conclusions of this scoping review (Cook, 2014). Methods Scoping reviews are a valuable instrument in the expanding toolbox of evidence synthesis techniques. Scoping reviews are preferred by researchers over systematic reviews when the latter’s goals include establishing a body of literature, explaining concepts, examining research methodologies, or detecting knowledge gaps. To produce reliable results, it must be carried out with strict and open procedures, even though their goals differ from those of systematic reviews. The methodological approach outlined by (Arksey, 2005) was followed. The intricacies of metrics and the broad spectrum of research form methodologies used in existing studies made it clear that a scoping examination was the optimal method to investigate the extensive literature on infertility indicators and fertility care. A review method was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR) to ensure a thorough and organized analysis. Below are the steps undertaken to conduct this review. Stage 1: Developing a Rationale and Identifying the Research Question These inquiries directed the scoping review. Which metrics show how SDG 3 is affecting Nigerian women’s ability to avert the psychological and physical consequences of infertility? What kinds of indicators are there, and what sizes are they? How are these indicators measured according to the reports? Which country map, by the info, has that is currently available? In this nation, which organizations are in charge of gathering data? Stage 2: Identifying Relevant Studies In the first phase, one bibliographic database was used to perform a preliminary limited search. Text terms found in the abstract were then examined, the title of the documents, and the index words used to characterize the articles. The search method was developed in the second phase after determination of the words found in texts and index phrases. There was additional refinement of this. Table 1 gives the search engine methods for the different databases. A systematic electronic search was conducted using PubMed, MEDLINE, Web of Science, CINAHL, and Scopus. Table 1: Search strategy keywords Bibliographic Database Search query PubMed "Women" [Mesh] AND ("Infertility" [Mesh] OR "assisted reproduction*" [tw] OR "infertility" [tw] OR "subfertility" [tw]) AND ("Patient Care/standards" [Mesh] OR "Health Care Quality Indicators" [Mesh] OR "indicator*" [tw]) MEDLINE Women/ AND (Infertility/ OR assisted reproduction*.mp. OR infertility.mp. OR subfertility.mp.) AND (Patient Care/standards/ OR Quality Indicators, Health Care/ OR indicator*.mp.) Web of Science Women AND (Infertility OR “assisted reproductive*” OR infertility OR subfertility) AND (“Patient Care/standards” OR “Quality Indicators, Health Care” OR indicator*) CINAHL (MH “Women+”) AND ((MH “Infertility+”) OR “assisted reproduct* OR infertility OR subfertility) AND ((MH “Patient Care/standards+”) OR (MH “Quality Indicators, Health Care+”) OR indicator*) Scopus INDEX TERMS ("Women") AND (INDEX TERMS("Infertility") OR TITLE- ABS-KEY ("assisted reproductive*") OR TITLE-ABS-KEY("infertility") OR TITLE-ABS-KEY("subfertility")) AND (INDEX TERMS ("Individual Well-being/ protocols.") OR INDEX TERMS ("Performance Measures”., Health Care") OR TITLE-ABS-KEY("indicator*")) Pa ge 37 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 Additionally, online resources such as the World Health Organization: The International Committee for Monitoring Assisted Reproduction Technologies (ICMART), The Nigerian Demographic Health Survey Organization, the International Federation of Gynecology and Obstetrics (FIGO), the United Nations Population Fund (UNFPA), and the American Academy of Pediatrics (AAP) were combined with the electronic search. Conference proceedings and reports from other related organizations were also searched. Some of these national ART surveillance system societies are affiliated with the Centers for Disease Control and Prevention (CDC, 2018), the African Network and Registry for Assisted Reproductive Technology (ANARA), and the International Federation of Fertility Society Surveillance 2019 (IFFS, 2019). In the end, the list of pertinent article references and citations made by relevant article logs that were not date-restricted was manually checked. Stage 3: Study Selection Inclusion Criteria Credible publications (which included every type of study, which involves both initial and subsequent research), demographic accounts (which included females seeking mental and physical care from infertility), and concept reports (which included indicators of infertility and conception prevention and treatment through the impact of SDG3) were included in this study. The search was limited to research that was accessible in the English language. Exclusion Criteria Literatures which did not undergo peer review due to concerns about the source’s reliability was excluded from this scoping review. Bias may be introduced by including data from unpublished studies and thus unpublished studies were excluded. Literatures that would be difficult to translate due to linguistic quirks can also add bias to this scoping review and were excluded. Stage 4: Charting the Data To identify important information and determine whether it supports the aims and objectives of this scoping review, the data must be summarized as part of the analysis process. Data charting is the procedure used to create this summary. Table 2 below shows some articles examined during this scoping review. It summarizes African, low- and middle-income countries (LMICs), and Nigerian literature by region. Table 2: Data charting Region Country Author(s)/Date Study Type Aim W es t A fr ic a Cameroon Egbe et al., 2020 Quantitative To determine the prevalence and associated factors of infertility in Douala, Cameroon The Gambia Dierickx, et al., 2019 Qualitative Long-term ethnographic study The Gambia Dierickx, et al., 2021 Qualitative Long-term ethnographic study The Gambia Dierickx, et al., 2022 Qualitative Long-term ethnographic study Ghana Adofo, 2021 Qualitative To explore factors that influence family planning uptake after the first delivery, including fear of infertility. Ghana Alhassan et al., 2014 Qualitative To examine prevalence and severity of depression in relation to age, type of infertility and duration of infertility in Ghanaian infertile women. Ghana Anokye, et al., 2017 Qualitative To determine the psychosocial effects of infertility among couples Ghana Anaman-Torgbor et al., 2021) Qualitative To explore the experiences of women undergoing ART treatment Ghana Fledderjohann, J.J., 2012 Qualitative To explores the implications of infertility for women in Ghana Ghana Osofu & Hanninen, 2020 Qualitative To document lived experiences of infertile women and on how they can be helped to improve their own condition Ghana Naab et al., 2013 Qualitative To describe infertile women’s psychosocial health problems and their infertility-related beliefs Ghana Tabong & Adongo, 2013 Qualitative Exploratory study on causes of infertility Pa ge 38 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 Mali Hess, et al., 2018 Mixed Methods To examine infertility-induced psychological distress and coping strategies among women in Mali Niger Samandari et al., 2019 Qualitative individual and structural factors influencing married girls’ early first birth Nigeria Abarikwu, 2013 Literature review and secondary data analysis Review to identify risk factors for male- factor infertility in Nigeria Nigeria Adegbola & Akindele, 2013 Quantitative To examine the pattern of infertility cases amongst infertile couples seeking care Nigeria Aduloju, 2018 Quantitative To examine the quality of life in women of reproductive age and compare the quality- of-life scores among fertile and infertile women Nigeria Bello et al., 2021 Mixed methods Implementation Research Protocol To assess psychoeducational evaluate its effectiveness for reducing symptoms of anxiety and depression in infertile populations Nigeria Dimka & Dein, 2013 Qualitative Ethnographic study documenting impact of infertility on women’s lives Nigeria Ibisomi & Mudege, 2013 Qualitative To explore societal perception and acceptance of childlessness in Nigeria Nigeria Ikimalo & Babatunde, 2012 Qualitative To investigate perceptions of infertility among urban residents of Port Harcourt, Nigeria Nigeria Iliyasu et al., 2013 Qualitative To determine the public perception of infertility, its causes and factors associated with acceptability of ART Nigeria Larsen et al., 2010 Mixed methods To examine the experiences of women with infertility in Nigeria Nigeria Okafor et al., 2017 Qualitative To explore the perceptions of infertility and IVF and how to enhance the use of IVF treatment among married couples Nigeria Omoaregba et al., 2011 Qualitative To determine the prevalence of psychological distress as well as its associated socio-cultural characteristics among women attending infertility clinics Nigeria Ndubuisi et al., 2021 Qualitative To assess the impact of infertility on the sexual life of women with infertility seeking care Nigeria Whitehouse & Hollos, 2014 Qualitative To explore experiences of infertility by types of infertility (low, childless) C en tra l A fr ic a Rwanda Dhont et al., 2011 Mixed methods To understand the socio-cultural consequences of infertility Rwanda Dhont, 2011 Quantitative To examine predictors for infertility and treatment-seeking behavior E as t A fr ic a Ethiopia Akalewold, et al. 2022 Quantitative Hospital-level survey on factors driving infertility Kenya Ochako et al., 2015 Qualitative To explore reasons for contraceptive hesitancy, for which fear of infertility was a major factor Kenya Njogu et al., 2022 Qualitative To describe women’s fertility treatment and experiences Pa ge 39 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 Kenya Sedlander et al., 2018 Qualitative To understand how beliefs that modern contraceptives cause infertility shapes behavior? Unclear Kenya Sedlander et al., 2021 Quantitative To conduct sociocentric network analysis to explore if beliefs that contraceptives effect infertility result in low use Kenya, Tanzania WHO (Bulletin) Key Informant Interview Interview with healthcare providers on Maasai experiences of infertility Malawi Bornstein, et al, 2020 Qualitative To understand the production and impact of infertility-related stigma Malawi Chipeta et al., 2010 Qualitative To explore factors that affect the intentions of men and women to use family planning methods Malawi Parrot, 2014 Qualitative Ethnographic research on how men’s reproductive bodies are problematized and biomedically defined diagnoses contribute to the visibility of male infertility Stage 5: Compiling, Analyzing, and Presenting the Findings 147 unique indicators were identified. These indicators were categorized conceptually into classes (including structural, process, and outcome), and characteristics (dimensions) such as safe, effective, patient-centered, timely, efficient, and equitable) using pre-established analytical frameworks (Davies, 2004; Runstein, 2004). Two analytical frameworks were applied to arrange the whole set of mapped indicators. The Donabedian framework (Donabedian, 1988) outlined the various classes of indicators (see Table 3), while the Institute of Medicine (IOM) structure outlined the characteristics (dimensions) of indicators, such as promptness, productivity, equality, safety, and efficacy (see Table 4). Table 3: Classes of Indicators Classes Explanation Structural Foundational markers, which include staffing levels, funding, beds, supplies, and physical facilities, are used by health systems and organizations to provide services and programs. These indicators characterize the quantity and kind of resources. Process Process indicators make use of the generally recognized guidelines for clinical practice. Healthcare professionals' actions and their quality are assessed by process indicators, which are collections of related actions performed to achieve certain goals. Outcome The impact of medical services on patients' health conditions is demonstrated by outcome indicators. Table 4: Characteristics (Dimensions) of Indicators Dimensions Explanation Safe By providing care for individuals that is meant to be beneficial, thereby preventing harm to them. Effective By avoiding serving those who are unlikely to benefit, or underusing or misusing services based on scientific information, sustainable development target 3 aims to serve everyone who might benefit. Patient- centered Making sure that all clinical decisions are based on the values of the patient and providing care that is sensitive to and cognizant of each patient's individual needs, preferences, and values. Timely Reducing waiting times and possibly hazardous delays for care providers and recipients. Efficient Making sure everyone is healthy and happy while avoiding destruction, such as discarding of tools, supplies, concepts, and energy resources. Equitable It offers attention and empathy whose quality is constant regardless of the patient's socioeconomic status, location, gender, or race. RESULTS AND DISCUSSION 1,340 reports came from the electronic search, and 91 more reports were found through other means. Following removal of duplicates, 169 entire text publications were assessed for inclusion by screening the titles and abstracts. Finally, 46 reports were included in this scoping review using the PRISMA Flowchart as illustrated in Figure 1. Pa ge 40 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 Figure 1: PRISMA Flowchart illustrating the screening and reporting process for the scoping literature review Figure 2: Range of parameters and categories of infertility indicators reported The types (classes) of indicators (outcome, process, and structure) are represented by the inner doughnut and the characteristics of indicators (effectiveness, efficiency, equity, patient-centeredness, safety, and timeliness) are represented by the outer doughnut, indicating the relative abundance of published work (see Fig. 2 above). Except for a small number of process indicators (16.34%) and structure indicators (13.94%), the majority of the indicators (69.72%) were outcome indicators (see Table 5). Equity, patient-centeredness, safety, and timeliness indicators were less prevalent in dimension, with effectiveness (41.43%) and efficiency (44.62%) accounting for most indicators (see Table 5). Pa ge 41 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 Table 5: Types and dimensions of indicators showing their percentage levels Types Dimensions Effectiveness Efficiency Equity Patient- centeredness Safety Timeliness Outcome 87 82 0 0 6 0 175 (69.72%) Process 10 14 1 3 6 7 41 (16.34%) Structure 7 16 3 3 6 0 35 (13.94%) 104 (41.43%) 112 (44.62%) 4 (1.59%) 6 (2.39%) 18 (7.17%) 7 (2.80%) The frequency of infertility in developing nations is covered in comparatively few publications. Less developed countries have rates between 6.9 and 9.3%, according to (Boivin, 2020). The incidence varies significantly by region, and these variations can be primarily attributed to various environmental, cultural, physical, psychological, and social factors. This ignorance of fertility and infertility in Nigeria may result in a delayed or insufficient diagnosis or course of treatment, which could have a detrimental effect on a person’s or a couple’s health. Moreover, it might reinforce societal stigmas, negative physical and mental health impacts like aggression and despair, problems related to infertility, and prevent more help-seeking behaviors. Lack of fertility awareness in Nigeria restricts women from controlling their fertility (McCurdy, 2015; Iyanda, 2020). An essential comprehension of conception and the cycle of menses is known as fertility awareness (Iyanda, 2020), which was reported on the most recent estimates of DHS (Demographic Health Survey) information gathered among women in 29 African nations and revealed that women had the most inaccurate information regarding ovulation and fertility. The lack of awareness and comprehension regarding fertility and infertility in Nigeria may cause women’s health to suffer and result in a delayed or insufficient diagnosis or course of therapy for infertility. Moreover, it could reinforce societal stigmas related to infertility and dissuade people from getting help. To improve infertility understanding and reduce the stigma associated with infertility, expanding Sexual and Reproductive Health therapy and other programs promoting fertility awareness could be an excellent place to start. There is variation in the definition and nomenclature of the phrase “fertility awareness”. DHS data frequently uses simple questions to gauge a woman’s level of fertility awareness, such as when her period is most likely to end (McCurdy, 2015). While many studies in the more extensive literature aim to comprehend “various facets of conception and knowledge of fertility across the lifespan and in various contexts, as well as certain related attitudes and actions,” many of them do not have a precise definition of fertility awareness (Kudesia, 2018). Instead, they focus on understanding these various aspects of knowledge and beliefs. When defining fertility awareness broadly, cognitive, social, environmental, and developmental effects that impact behavior across the life course are included (McCurdy, 2015). In certain instances, the concept of fertility awareness has broadened to encompass details about the onset of fertility and physical changes that accompany puberty in both girls and boys, the return to fertility following childbirth or an abortion, the chance of pregnancy for women who are nursing or not, the fluctuating nature of fertility and the risk of fertility during the period of menstruation, discernible changes throughout the monthly cycle, such as indicators of a woman’s fertility, male fertility, how methods of contraception influence the probability of conception, possible adverse effects of family planning techniques, and situations related to ageing and infertility/subfertility. Most people agree that SRH attitudes and actions are negatively impacted throughout life by low fertility awareness. These behaviors include not using family planning, using delayed methods after giving birth or an abortion, quitting a technique, using ineffective methods, getting pregnant unintentionally, and having false beliefs about being infertile. Despite the challenge of estimating the effects of fertility awareness in programs, several studies and SDG3 indicate that doing so adds substantial value to individual and community- level interventions, increasing knowledge and positively influencing social norms surrounding fertility and infertility (Dyer, 2002). Both nationally and globally, infertility has received more attention due to a growing understanding of the severity and effects of the condition and ongoing developments in accessible treatment choices (Ombelet, 2014; Hammarberg, 2013). Human rights reports, national health plans, and SDG advancement are all starting to incorporate infertility treatments and initiatives (Davis, 2020). The SDGs research suggests that addressing the needs and priorities of public health inside nations requires a more integrated national, regional, and global approach, as well as the current and emerging health needs related to infertility, rather than keeping the same priorities set thirty years ago. For this reason, the 2030 agenda includes these goals. The primary objective of Sustainable Development Goals is to “enhance the methods of implementation and rejuvenate the worldwide partnership for sustainable development” (Batram, 2018). This addresses associated stigma, creates information networks to track and identify infertility, its causes, and its effects, and expedites Pa ge 42 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 programs to address infertility, outstanding reproductive care, prevent, and treat infertility, as well as improve programs for physical, research, infrastructure for public health, mental and psychological support, and regulations. The influence of SDG3 on infertility prevention together with the physical and mental effects of infertility in Nigerian women, were examined in this scoping review of studies published in English language. The strengths of this scoping review include the fact that works from grey literatures were excluded. This scoping review concentrated on natural causes of female infertility instead of the narrative-based ones often seen in the literature. The primary limitation of this scoping review is the small number of publications which addressed the specific research topic, according to an initial analysis. Since many studies that tried to determine the causes of female infertility made varying attempts, it required some time to find papers that precisely tackled the topic of the research to provide a comprehensive review. For example, many studies concentrated on prevalence rather than causes and risk factors. Since publications in other languages were not included, this scoping review’s focus was restricted to studies published in English language. CONCLUSION Nigeria’s infertility problem demands sufficient attention and needs to be addressed by all relevant stakeholders. Based on published studies, infertility among Nigerian women has both physical and mental effects which are poorly understood, with genuine causes not fully understood. Knowledge gaps still exist that must be filled in order to comprehend fully the true causes of female infertility. A thorough comprehension of the physical and mental effects of infertility among Nigerian women may potentially result in the recognition of more efficient initial prevention and intervention strategies for female infertility. Acknowledgment Special thanks to everyone who contributed in one way or the other to make this research a reality. Your assistance in conducting this research can never be denied. REFERENCES Aliu-Ayo, H. I., Adesina, K. T., Jimoh, A. A. G., Ikwuka, A. O., Udeh, F. C., Biliaminu, S. A., & Ayo, O. W. (2023). Serum levels of thyroid hormones in infertile and fertile women attending a tertiary care hospital in North-Central Nigeria: A comparative reproductive medicine study. American Journal of Medical Science and Innovation, 2(2), 141-152. https://doi.org/10.54536/ ajmsi.v2i2.2044 Aliu-Ayo, H. I., Adesina, K. T., Jimoh, A. A. G., Ikwuka, A. O., Udeh, F. C., Biliaminu, S. A., & Ayo, O. W. (2023)b. Correlation of Thyroid Gland Functions with Menstrual Patterns amongst Infertile and Fertile Women Attending a Tertiary Care Hospital in North- Central Nigeria. World Journal of Clinical Medicine Research, 3(1), 13–26. https://doi.org/10.31586/ wjcmr.2023.787. Ama, M. I., Ikwuka, A. O., Udeh, F. C., Ekechi, H. O., & Eteudo, A. N. (2023). Sperm Parameters and Testicular Histology of Male Wistar Rats Treated with Phoenix dactylifera After Consumption of Local Mmahi Salt. American Journal of Bioscience and Bioinformatics, 2(1), 41- 51. https://doi.org/10.54536/ajbb.v2i1.2275. Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. Baysah, P. V., Ikwuka, A. O., Udeh, F. C., Bleh, D. P., & Viloria, T. (2023). Pathophysiological effects of alcohol and tobacco consumption on semen parameters of men attending a fertility clinic in West Africa. American Journal of Biomedical and Life Sciences, 11(4), 73-81. https://doi.org/10.11648/j. ajbls.20231104.13. Beutel, M., Kupfer, J., Kirchmeyer, P., & et al. (1999). Treatment-related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI. Andrologia, 31(1), 27-35. Boivin, J., Carrier, J., Zulu, J. M., & Edwards, D. (2020). A rapid scoping review of fear of infertility in Africa. Reproductive Health, 17(1), 142-9. Bowa, K., Kasonde, O., & Kachimba, J. (2012). Male infertility from the developing nation perspective. In Springer eBooks. https://doi.org/10.1007/978-1-4614- 3335-4_15 Centres for Disease Control and Prevention. (2018). Assisted Reproductive Technology Fertility Clinic Success Rates Report. Atlanta, GA: U.S. Department of Health and Human Services. Cook, J. E., Purdie-Vaughns, V., Meyer, I. H., et al. (2014). Intervening within and across levels: A multilevel approach to Stigma and public health. Social Science & Medicine, 103, 101–109. Cousineau, T. M., & Domar, A. D. (2007). The psychological impact of infertility. Best Practice & Research Clinical Obstetrics & Gynaecology, 21(2), 293- 308. Daar, A. S., & Merali, Z. (2002). Infertility and social suffering: The case of ART in developing countries. Geneva, Switzerland: World Health Organization. Davies, M. J., Wang, J. X., & Norman, R. J. (2004). What is the most relevant standard of success in assisted Reproduction? Assessing the BESST index for reproduction treatment. Human Reproduction, 19, 1049–1051. Davis, M. F., & Khosla, R. (2020). Infertility and human rights: A jurisprudential survey. Columbia Journal of Gender and Law, 40(1), 1-45. Domar, A. D., Zuttermeister, P. C., & Friedman, R. (1993). The psychological impact of infertility: A comparison with patients with other medical conditions. Psychosomatic Obstetrics & Gynaecology, 14(Sl), 45–52. Donabedian, A. (1988). The quality of care: How can it Pa ge 43 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 be assessed? JAMA, 260, 1743–1748. Dyer, S. J., Abrahams, N., Hoffman, M., & Van der Spuy, Z. M. (2002). Infertility in South Africa: Women’s reproductive health knowledge and treatment-seeking behaviour for involuntary childlessness. Human Reproduction, 17(6), 1657–1662. Ekechi, H. O., Ikwuka, A. O., Udeh, F. C., & Abraham, J. C. (2023). Effects of ethanol extract of Rauwolfia vomitoria leaf on lipid profile and cerebellar histology in cisplatin-induced oxidative stress. British Journal of Medical and Health Research, 10(5), 16-39. https://doi. org/10.5281/zenodo.8042521 Ekechi, H. O., Ikwuka, A. O., Udeh, F. C., Epete, M. A., & Uche, V. U. (2023). Hepatorenal protective functions of coconut water in alloxan-induced type 1 diabetes mellitus. World Journal of Current Medical and Pharmaceutical Research, 5(4), 114-122. https://doi. org/10.37022/wjcmpr.v5i4.276 Evens, E. M. (2004). A Global Perspective on Infertility: An Under Recognized Public Health Issue. Carolina Papers in International Health, No. 18. University Center North Carolina at Chapel Hill. Greil, A. L. (1997). Infertility and psychological distress: A critical review of the literature. Social Science & Medicine, 45(11), 1679-1704. Hammarberg, K., & Kirkman, M. (2013). Infertility in resource-constrained settings: Moving towards amelioration. Reproductive Biomedicine Online, 26(2), 189–195. Ikwuka, A. O. (2015). Risk factors for the pathogenesis of diabetes mellitus type 2. In Materials of 84th Scientific and Practical Conference of Students and Young Scientists with International Participation Innovations in medicine (p. 19). http://www.ifnmu.edu.ua/images/snt/files/ konferenciya/Tezu_2015.pdf Ikwuka, A. O. (2017)a. Dyslipidemia risk severity in patients with diabetes mellitus type 2 and essential hypertension. Journal of the 21st International Medical Congress of Students and Young Scientists, p. 59. Ikwuka, A. O. (2017). Effectiveness of dapagliflozin in patients with diabetes mellitus type 2 and essential hypertension. In Book of abstracts of the 7th International Students’ Scientific Conference of Young Medical Researchers (p. 102). http://www.stn.umed.wroc.pl/files/lm/ Accepted_papers.16113.pdf Ikwuka, A. O. (2017)c. Influence of dyslipidemia in patients with diabetes mellitus type 2 and essential hypertension. The Pharma Innovation Journal, 6(3), 101- 103. Available online: http://www.thepharmajournal. com/archives/?year=2017&vol=6&issue=3&part=B Ikwuka, A. O., & Haman, I. O. (2017). Features of kidney damage in patients with diabetes mellitus type 2 and essential hypertension. In Journal of 86th Scientific and Practical Conference of Students and Young Scientists with International Participation “Innovations in medicine” (p. 144). http://www.ifnmu.edu.ua/images/snt/86- konf-tezi%20(1).pdf Ikwuka, A. O., Virstyuk, N. G., & Luchko, O. R. (2017). Features of the functional state of kidneys in patients with diabetes mellitus type 2 and essential arterial hypertension. In Materials of scientific-practical conference with international participation “Babenkivski reading” (p. 48). Ikwuka, A. O. (2018). Clinical dynamics in patients with diabetes mellitus type 2 and concomitant essential hypertensive disease treated with dapagliflozin. Journal of the 22nd International Medical Congress of Students and Young Scientists, p. 32. Ikwuka, A. O. (2018). Clinical effectiveness of SGLT- 2 inhibitors in patients with diabetes mellitus type 2 and essential hypertensive disease. Endocrine Practice, 24(1), 74. https://doi.org/10.1016/S1530- 891X(20)47129-0 Ikwuka, A. O. (2018). Features of kidney damage in patients with arterial hypertension and type 2 diabetes mellitus and optimization of treatment. Specialized Academic Council IFNMU. http://www.ifnmu.edu.ua/ images/zagalna_informacia/spec_vcheni_radi/2017- 2019/%D0%9420.601.01/Ikvuka/Avtoreferat.pdf Ikwuka, A. O., & Paliy, Yu. (2018). Structural changes of the left ventricular myocardium in patients with essential arterial hypertension and diabetes mellitus type 2. In Abstracts of the 87th Scientific Conference of Students and Young Scientists with International Participation “Innovations in medicine” (pp. 25-26). Retrieved from https://www. ifnmu.edu.ua/images/snt/zaproshennia_eng.pdf Ikwuka, A. O. (2019). Clinical dynamics of nephropathy in patients with diabetes mellitus type 2 and concomitant essential hypertensive disease. Clinical Medicine, 19(2), s39. https://doi.org/10.7861/clinmedicine.19-2-s39 Ikwuka, A. O. (2019). Clinical effectiveness of GLP-1 RAs in patients with metabolic syndrome diseases. Endocrine Practice, 25(1), 104-105. https://doi. org/10.1016/S1530-891X(20)46611-X Ikwuka, A. O., & Virstyuk, N. G. (2019). Pattern of cardiac remodeling of the left ventricle in patients with essential hypertensive disease and concomitant type 2 diabetes mellitus. Clinical Medicine, 19(3), s92. https://doi.org/10.7861/clinmedicine.19-3-s92 Ikwuka, A. O., & Virstyuk, N. G. (2021). Influence of SGLT2 inhibitor and A2RB (AT1) on fibrogenesis and heart failure in patients with essential hypertensive disease combined with diabetes mellitus type 2. E-Poster No. 143 presented at the 44th & 45th Annual General and Scientific Meeting of the West African College of Physicians (WACP), 1 - 3 November, 2021. https://doi.org/10.13140/RG.2.2.26912.87047 Ikwuka, A. O., & Virstyuk, N. (2022). Prognostic markers of nephropathy in patients with dual metabolic syndrome diseases (essential hypertensive disease and concomitant type 2 diabetes mellitus). Endocrine Practice, 28(5), S65-S66. https://doi.org/10.1016/j. eprac.2022.03.164 Ikwuka, A. O. (2023). Dr. Aloy’s Core Essential Series (DACES) Medical Genetics (1st ed.). Science and Education Publishing. Pa ge 44 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 Ikwuka, A. O. (2023). Dr. Aloy’s Core Essential Series (DACES) Immunology (1st ed.). Science and Education Publishing. Ikwuka, A. O., & Virstyuk, N. (2023). Patterns and influence of cardio-metabolic insufficiency in patients with essential hypertensive disease and concomitant type 2 diabetes mellitus. Endocrine Practice, 29(5), S32-S33. https://doi.org/10.1016/j. eprac.2023.03.076 Ikwuka, A. O., Virstyuk, N. G., Luchko, O. R., & Kobitovych, I. (2023). Heterogeneity of renal pathogenicity on the background of asymptomatic hyperuricemia in patients with dual metabolic syndrome diseases (essential hypertensive disease and type 2 diabetes mellitus). British Journal of Medical and Health Research, 10(2), 1-9. https://doi.org/10.5281/ zenodo.7690636 Ikwuka, A. O. (2023). Dr. Aloy’s Core Essential Series (DACES) Hematology (1st ed.). Science and Education Publishing. Ikwuka, A. O., Omoju, D. I., & Mahanera, O. K. (2023). Profiling of clinical dynamics of type 2 diabetes mellitus in patients: A perspective review. World Journal of Current Medical and Pharmaceutical Research, 5(5), 210- 218. https://doi.org/10.37022/wjcmpr.v5i5.294 Ikwuka, A. O., Virstyuk, N., Luchko, O., & Kobitovych, I. (2024). Optimization of treatment in MSD patients using a combination of HMG-CoA reductase inhibitor, SGLT-2 inhibitor and A2RB (AT1): Resultant clinical effectiveness. Endocrine Practice, 30(5), S60-S61. https://doi.org/10.1016/j. eprac.2024.03.243 Inhorn, M. C., & Patrizio, P. (2015). Infertility around the globe: New thinking on gender, reproductive technologies, and global movements in the 21st Century. Human Reproduction Update, 21(4), 411–426. Iyanda, A. E., Dinkins, B. J., Osayomi, T., Adeusi, T. J., Lu, Y., & Oppong, J. R. (2020). Fertility knowledge, contraceptive use, and unintentional pregnancy in 29 African countries: A cross-sectional study. International Journal of Public Health, 65(4), 445–455. Kaufman, J., et al. (1999). A study of field-based methods for diagnosing reproductive tract infections in rural Yunnan Province, China. Studies in Family Planning. https://doi.org/10.1111/j.1728-4465.1999.00112.x Koster-Oyekan, W. (1999). Infertility among Yoruba women: Perceptions on causes, treatments, and consequences. African Journal of Reproductive Health, 3(1), 13-26. https://doi.org/10.2307/3583225 Kroes, H., Siermann, M., Jansz, R., et al. (2019). Breaking the silence around infertility: A narrative review of existing programs, practices, and interventions in low- and lower-middle-income countries. Share- Net International Co-Creation Conference, Amsterdam, Netherlands. Kudesia, R., Muyingo, M., Tran, N., Shah, M., Merkatz, I., & Klatsky, P. (2018). Infertility in Uganda: A missed opportunity to improve reproductive knowledge and health. Global Reproductive Health, 3(4), e24. Mascarenhas, M. N., Flaxman, S. R., Boerma, T., et al. (2012). National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLoS Medicine, 9(12), e1001356. McCurdy, R., & Schnatz, P. (2015). Fertility awareness in adolescents in sub-Saharan Africa: Evidence from Demographic and Health Surveys. Obstetrics and Gynecology, 125(1), 85S. Munn, Z., Peters, M. D. J., Stern, C., et al. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18, 143. Nahar, P. (2022). Childlessness in Bangladesh: Intersectionality, suffering and resilience. Oxfordshire: Routledge. Okonofua, F. E. (2002). Sociocultural perceptions of fertility and infertility among rural Edo women in discovering normality in health and the reproductive body. PAS Working Papers, 11, 63–69. Ola, T. M., Aladekomo, F. O., & Oludare, B. A. (2008). Determinants of the choice of treatment outlets for infertility in Southwest Nigeria. Rawal Medical Journal, 33(2), 193–196. Ombelet, W. (2011). Global access to infertility care in developing countries: A case of human rights, equity, and social justice. Facts, Views & Vision in ObGyn, 3(4), 257. Ombelet, W. (2014). Is global access to infertility care realistic? The Walking Egg Project. Reproductive BioMedicine Online, 28(3), 267–272. Orji, E. O., Kuti, O., & Fasubaa, O. B. (2002). Impact of infertility on marital life in Nigeria. International Journal of Gynaecology and Obstetrics, 79(1), 61-62. Orji, E. O. (2008). Comparative study of the Impact of past pregnancy outcome on future fertility. Singapore Medical Journal, 49(12), 1021–1024. Ritchie, H., Roser, M., Mispy, S., & Ortiz-Ospina, E. (2018). Measuring progress towards the Sustainable Development Goals (SDG 3). Available online: www. SDG-Tracker.org Runstein, S. O., & Iqbal, H. S. (2004). Infecundity, infertility, and childlessness in developing countries. DHS Comparative Reports, 9. Sharma, S., Mittal, S., & Aggarwal, P. (2009). Management of infertility in low-resource countries. BJOG: An International Journal of Obstetrics & Gynaecology, 116, 77–83. Starrs, A. M., Ezeh, A. C., Barker, G., Basu, A., Bertrand, J. T., Blum, R., et al. (2018). Accelerate progress—sexual and reproductive health and rights for all: Report of the Guttmacher–Lancet Commission. The Lancet, 391, 2642–2692. Tanywe, A., & Matchawe, C. (2018). Experiences of women living with infertility in Africa: A qualitative systematic review protocol. JBI Evidence Synthesis, 16(9), 1772-1778. Umezulike, C., & Efetie, R. (2003). The psychological trauma of infertility in Nigeria. International Journal of Pa ge 45 https://journals.e-palli.com/home/index.php/ajlsi Am. J. Life Sci. Innov. 3(2) 33-45, 2024 Gynaecology and Obstetrics, 84(2), 178-180. United Nations. (2015). Resolution adopted by the General Assembly on September 25, Transforming our world: the 2030 Agenda for Sustainable Development, (A/ RES/70/1). United Nations. (2017). Resolution adopted by the General Assembly on July 6, 2017. Work of the Statistical Commission about the 2030 Agenda for Sustainable Development, (A/RES/71/313). Van der Poel, S. (2012). The focal point for infertility on behalf of WHO/RHR and HRP2012. Health IfR. FACT Project’s WALAN Group Learning and Counseling Model. Washington, D.C. Available online: https://www.irh.org/walan-group-learning- counseling/ Virstyuk, N. G., Ikwuka, A. O., Haman, I. O., & Adebomi, M. S. (2016). Diabetes mellitus type 2, arterial hypertension and dyslipidemia. Materials of 2nd International Scientific and Practical Conference Therapeutic readings: modern aspects of diagnosis and treatment of diseases of internal organs, p. 46-47. Virstyuk, N. G., & Ikwuka, A. O. (2017)a. Diagnostic and prognostic markers of the diabetes mellitus type 2 course in connection with essential arterial hypertension taking into account the kidney function. Precarpathian Journal Pulse, 8(44), 53-62. Virstyuk, N. H., Ikwuka, A. O., Losyuk, L. V., Kobrynska, O. Ya., & Markiv, H. D. (2017)b. Dapagliflozin utility in patients with diabetes mellitus type 2 and essential hypertensive disease. Actual Problems of Modern Medicine, 4(60)1, 76-79. Available online: http://www. umsa.edu.ua/journal2stat4_2017_eng.html Virstyuk, N. G., & Ikwuka, A. O. (2018a). Features of asymptomatic hyperuricemia in patients with diabetes mellitus type 2 and concomitant essential arterial hypertension. Clinical and Experimental Pathology, 1(63), 22-26. https://doi.org/10.24061/1727-4338. XVII.1.63.2018.5 Virstyuk, N. G., Ikwuka, A. O., & Didushko, O. M. (2018b). Effect of dapagliflozin on the level of uric acid during asymptomatic hyperuricemia in patients with diabetes mellitus type 2 and concomitant arterial hypertension. Art of Medicine, 1(5), 21-26. https://art- of-medicine.ifnmu.edu.ua/index.php/aom/article/ view/179 Virstyuk, N. H., & Ikwuka, A. O. (2018c). Dapagliflozin influence on the clinical course of diabetes mellitus type 2 and essential hypertension in patients. In Recent Advances in Environmental Science from the Euro- Mediterranean and Surrounding Regions (pp. 2007-2008). https://doi.org/10.1007/978-3-319-70548-4_582 Virstyuk, N. G., & Ikwuka, A. O. (2019). Nephropathic characteristics in patients with diabetes mellitus type 2 and essential hypertensive disease. Art of Medicine, 1(5), 44-47. https://doi.org/10.21802/artm.2019.1.9.44 Virstyuk, N. G., & Ikwuka, A. O. (2021a). Asymptomatic hyperuricemia and functional state of the kidneys in patients with essential arterial hypertension and concomitant diabetes mellitus type 2. European Journal of Clinical Medicine, 2(3), 100-104. https://doi. org/10.24018/clinicmed.2021.2.3.65 Virstyuk, N. H., Ikwuka, A. O., Luchko, O. R., & Kocherzhat, O. I. (2021b). Peculiarities of renal insufficiency in patients with diabetes mellitus type 2 and arterial hypertension. In Materials of scientific-practical conference with international participation “Achievements and prospects of experimental and clinical endocrinology” Twentieth Danilevsky readings (pp. 86-87). World Health Organization. (2020). Infertility. Factsheet. https://www.who.int/news-room/fact-sheets/ detail/infertility World Bank Development. (2023). Indicators, Nigeria country brief. http:/www.worldbank.org