Male Factor Infertility: Knowledge, Attitude, and Health-Seeking Behavior of Men in a Cosmopolitan Setting — A Cross-Sectional Study in Calabar, Cross River State, Nigeria

Abstract

Background: Male factor infertility contributes to nearly half of all cases of couple infertility globally, yet men's knowledge, attitude, and health-seeking behavior towards it remain understudied in Sub-Saharan Africa, where socio-cultural norms often place the burden of infertility on women. This study assessed the knowledge, attitude, and health-seeking behavior of men towards male factor infertility in Calabar, a cosmopolitan capital city in Cross River State, Nigeria. Methods: A descriptive cross-sectional study was conducted among 384 adult men aged 18–60 years, selected by multistage sampling across the two urban local government areas of Calabar metropolis. Data were collected using a semi-structured, interviewer-administered questionnaire covering sociodemographic characteristics, knowledge of male infertility, attitude towards it, and health-seeking behavior. Data were analyzed using SPSS version 26, with descriptive statistics and chi-square tests of association at a 5% significance level. Andersen's Behavioral Model of Health Services Use guided the analysis of predisposing, enabling, and need-based determinants of health-seeking behavior. Results: Overall, 24.0% of respondents demonstrated good knowledge, 41.8% fair knowledge, and 34.2% poor knowledge of male factor infertility. While 61.7% agreed that men should have semen analysis when a couple fails to conceive, 46.9% still viewed male infertility as a source of shame, and 38.3% believed traditional or spiritual remedies could cure it. Among men who had ever had fertility-related concerns, only 31.5% first sought care at a hospital or fertility clinic, while the remainder consulted traditional healers (24.8%), religious/spiritual centres (19.6%), patent medicine vendors (15.2%), or sought no care at all (8.9%). Educational attainment and knowledge level were significantly associated with orthodox health-seeking behavior (p < 0.05). Conclusion: Despite residing in a cosmopolitan urban setting with access to modern health facilities, men in Calabar demonstrate suboptimal knowledge and predominantly non-orthodox health-seeking behavior regarding male factor infertility, driven by persistent stigma and socio-cultural beliefs. Targeted male-focused reproductive health education and integration of male infertility services into routine primary and andrology care are recommended.