Perception of Key Ethical Issues in Assisted Reproductive Technology (ART) by Providers and Clients in Nigeria

Figures & data

Table 1 Summary of ART Providers and Clients Opinions on Key Ethical Issues

Key Ethical Issues	ART Providers/clinic directors (3 in number)	ART Clients (8 in number)
ART Access	It should be on demand since clients pay out-of-pocket.	It should be available on demand (6 clients) It should be for legitimate reasons like infertility, genetic disorders, or cancer treatment (2 clients--(43-year-old medical practitioner, (48-year-old laboratory scientist
Source of information on ART	Mostly previous successful clients.	Relatives and friends who had successful treatment.
Sexual orientation and type of marriage	It is unacceptable because LGBTQ is against the Nigerian Law (2 providers) Sexual orientation should not preclude access. It is one’s choice (54-year-old ART provider)	There should be non-access for LGBTQ because it is against cultural/religious belief (7 clients) There should be no discrimination (30-year-old immigration officer)
Marital Status	Offers to only married couples ((57-year-old ART provider) Single women are expected to come with a partner (47-year-old ART provider) Marital status should not be a discriminatory factor (54-year-old ART provider)	Single women should adopt (6 clients) It is a woman’s right to access any means of having her own baby (37-year-old Igala businesswoman; 30-year-old immigration officer)
Family balancing	It should be encouraged particularly in Africa where a family is incomplete without a male child (2 Providers) Sex selection is unacceptable even for genetic disorders, couples should adopt (57-year-old ART provider)	It is a welcome opportunity because without a male child, a woman has no share in her matrimonial home.
Female Age	Female age should not be a discriminatory factor because donor gametes can be used.	This is Africa and every woman irrespective of age should be helped to have a child of her own.
Acceptable number of transferred embryos	5 embryo transfer per cycle among practitioners though 3 is the number allowed in the AFRH guideline.	5 embryos and welcome multiple pregnancy
Cryopreservation	Acceptable because it reduces cost, and the complications of re-stimulating the ovaries should there be a failed cycle and client wants to try again (2 providers) It is unacceptable due to the risk of congenital anomalies that may result during the thawing process (57-year-old ART provider)	It is acceptable because it not only reduces cost but also prevents the risks from hormonal stimulation (6 clients including 2 Roman Catholic clients) It is unacceptable because it does not respect the dignity of the embryo (48-year-old laboratory scientist; 44-year-old pharmacy rep, both Roman Catholics)
Cost	It is expensive because ART is mostly private sector driven and it is unsubsidized by government.	It is expensive and clients save for long periods, borrow money, or sell property.
Information disclosure	Adequate informed consent and risk disclosure paramount.	Based on experience in centres accessed, Information disclosure inadequate No discussion on number of eggs retrieved or embryos made Transcript of information given only after transfer made (30-year-old immigration officer) Consent signed only after final transfer phase
Need for regulation	To avoid abuse, ART practice should be regulated by the State	Government should regulate ART to avoid women being exposed to inappropriate practice.