Understanding male infertility

Mr and Mrs Usman have been married for two years but without conception. Family and friends began to show concern for the couple while some often jokingly asked when they would call them for the naming ceremony of their baby. Most of those concerned directed their questions and advice to the wife because it is […]

Mr and Mrs Usman have been married for two years but without conception. Family and friends began to show concern for the couple while some often jokingly asked when they would call them for the naming ceremony of their baby.

Most of those concerned directed their questions and advice to the wife because it is widely believed in Africa that the woman is to blame when there is no conception.

Mrs Usman suggested they should go for medical examination but her husband refused to on the ground that he had a good sex life and was also healthy.

She took the bold step and went for the examination. She was given a clean bill of health and advised to come with her husband. A close relative had to intervene before Usman reluctantly subjected himself for the necessary medical examinations. He was diagnosed of low sperm count and treatment commenced immediately. The couple is today blessed with two sons.

Some people are still unaware that infertility is not a matter of gender but a condition that affects both men and women. Most studies have focused on women infertility; only few have included male participants, and most of these were aimed at assessing the prevalence and aetiology of male infertility.

Research revealed that, infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples. Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall.

Dr Ngonadi Nnamdi, head of Unit, Obstetrics and Gynaecology, Kuje General Hospital, defined male infertility as the inability of couples to achieve pregnancy after one year of unprotected sexual intercourse.

He said for any couple to be considered infertile, they must have lived together in the same house and have adequate number of sexual intercourse – at least three to four times weekly.

He said infertility could be primary or secondary, explaining that primary infertility occurs when a couple has not conceived before, while secondary infertility is a situation where pregnancy has occurred before but unable to conceive or have more babies.

Dr Ngonadi said both males and females could be affected by infertility. He said there are several factors that cause male infertility and foremost among them is congenital malformation, also known as chromosomal abnormality in males whereby the testes fail to develop. This accounts for a great number of men infertility.

According to the gynecologist, other causes include, abnormality in the baby whereby you have undescended testes, that is, the testes do not go down to the scrotum but remain in the abdomen or renal canal. The infection of mumps as a baby can later lead to infection of the testes called orchitis, surgeries in childhood like hernia, and infections like gonorrhea and other urinary infections which can lead to deformation of sperm, as well as testicular torsion where the testes undergo twisting (this is common in young men, it present with sudden severe pain at the testes).

Testicular torsion is a sudden medical emergency. If there is no adequate intervention it could lead to disruption of the testes thereby causing infertility in men.

Other causes include social habits (lifestyles can affect sperm formation), such as alcohol, cigarette smoking which can reduce sperm count in men; long distance driving, severe illnesses like diabetes, cancer particularly prostate cancer, toxic drugs, radiations, people with promiscuous lifestyle and those with chronic medical conditions can also be at risk of infertility.

Dr Ngonadi said male infertility could be prevented in many ways starting with change in the lifestyle of an individual; reducing the intake of alcohol, quitting smoking, regular medical checkup and, for surgeons to be careful during operation to avoid damage.

He added that another preventive measure is avoiding tight or warm wears that lead to injury and high temperature for the scrotum.

Dr Ngonadi advised that the best time to seek medical examination is when a couple living together and having regular sexual intercourse have not been able to achieve pregnancy within a year.

He said: “The couple is both supposed to present themselves in the hospital; it is not a one-sided treatment. The partners need to be there to encourage each other and give consent.

“It can be diagnosed from history like how long they have been together. However, there are other steps like physical examination to look at the man, examine his genital organs, look at the testes whether they are present in the scrotum, look at the sizes of the testes whether they have undergone entropy.

“Having done all these, you can proceed to seminal fluid analysis, here the man produces the sperm and takes it to the lab for sperm analysis. There are parameters to look out for from the analysis of the sperm, like  the volume of the sperm (normal sperm count should be above 60 million cells per mil, between 20-60 million tend to be normal, when less than 20 mil it is called oligospermia. When there is no cell at all, it is called azoospermia).

“Before you undergo the test, you are advised to abstain from sexual intercourse for few days before the actual date for the test,” he said.

Dr Ngonadi further explained that it is expected that the specimen should be collected through masturbation to ensure that the whole specimen is available, adding that they also look at the mobility to check whether the sperms are dead or alive.

“If it is less than 50% of them moving, it is not a good parameter but when 50% are moving it is taken as normal,” he stated.

The medical expert also said another parameter to look out for is the morphology, that is the shape of the sperm to know whether they are abdominal sperm cells, whether they have tail, one head or two heads.

He said there were a lot of treatments for male infertility and that they are based on the findings. If it is a mild problem you can start with change of lifestyle, counselling, prevention and treatment of infections.

“If there is low sperm count, you do more tests to know if the man has enough sex hormones that will help in spermatogenesis. When it is discovered that there is low level of sexual hormones, you can give hormonal drugs to stimulate the hormones to produce sperm,” he said.

Dr Ngonadi also said there could be surgical intervention if examination revealed that there is blockage in the spermatic cord. “In a situation where there is no sperm count at all, a donor is needed,” he said.

He said other forms of treatment include Intrauterine Insemination (IUI), and In Vitro Fertilisation (IVF). He said there was always room for adoption in cases of severe infertility.