Male Infertility: Infertility not just the woman’s headache
Newlywed Kate and Kingsley Buraimoh had no problem conceiving and giving birth to a baby within 10 months of their marriage. As such, nobody suspected what the immediate problem was when the couple found it difficult to achieve pregnancy two years after the birth of their first child.
As usual, Kate was the one who went through a series of tests to determine if she had suddenly ‘lost’ her ability to conceive. Things got to a head, however, when all the tests she did proved that she was perfectly normal to achieve pregnancy whenever she wanted.
The light was then turned on her husband, who, it turned out, was the one having fertility problem. Medical tests conducted on him proved that he was the one in need of medication to treat his infertility.
Welcome to the world of male infertility.
According to the Adjunct Professor at the University of Illinois at Chicago COMMAND Medical ART Centre, Prof. Oladapo Ashiru, it is very possible for a man who had had children before to find it difficult to get a woman pregnant. This depends on several factors, he said. One, in some people, the fertility will decline with age. Two, some can be exposed to environmental factors or occupational factors that can damage the sperm-producing organs of the body.
“Whether you call it infertility or sub-fertility depends on whether there is sperm production or no sperm production at all. A man that produces sperm but in low quantity (oligospermia) is probably a case of sub-fertility; while if there is no sperm at all (Azospermia) can be described as infertility.
Oligospermia was what the doctors diagnosed in the case of Jide Olawoyin when his wife could not conceive months after their marriage. Doctors had advised him and his wife to wait for two years before they concluded that they were infertile, but family pressure, which placed the blame at the doorsteps of the wife, would not let them.
Jide‘s wife went through a painful Hysterosalpingography (HSG) processes, but she was found to be normal.
The searchlight turned to Jide, and the doctors discovered that he had abnormal sperm counts.
‘Normal’ sperm count, as defined by the World Health Organisation, is characterised by: the concentration of spermatozoa, which should be at least 20 million per ml; the total volume of semen should be at least 2ml; the total number of spermatozoa in the semen should be at least 40 million; at least 75 per cent of the spermatozoa should be alive; at least 30 per cent of the spermatozoa should be of normal shape and form; at least 25 per cent of the spermatozoa should be swimming with rapid forward movement; at least 50 per cent of the spermatozoa should be swimming forward, even if only sluggishly.
While researching male infertility, Arvind Rup Singh, et al, of the Department of Medical Genetics and Fetal Medicine, University Hospital, Palacky University, Czech Republic, said the Y chromosome plays an important role in male infertility.
According to the scientists, the Y chromosome, though representing only 2-3 per cent of the haploid genome, harbours about 107 genes and pseudo genes. Many of these, they said, are responsible for spermatogenesis and other male-related functions; and deletion of any of these can result in infertility.
Also, Jörg Schlehofer of the German Cancer Research Centre in Heidelberg, who led a new research on male infertility, reported that a virus called Adeno-associated virus (AAV) might have a role in male infertility, though it is otherwise not harmful.
According to the scientists, “Mutation that alters human DNA adversely can cause infertility; the human body thus prevents the tainted DNA from being passed on.”
The scientists analysed semen samples from almost 100 men and found that 38 per cent of abnormal samples were infected with the AAV, compared with only 4.6 per cent of normal samples.
Again, according to a study conducted by a University of Illinois Associate Professor of Food Science and Human Nutrition, Manabu Nakamura, and released on April 13, 2010, Omega-3 fatty acids may be good for more than heart health.
Ashiru revealed that between 20 and 25 per cent of married couples have infertility problem, while about 40 per cent of the causes are due to male infertility.
The Medical Director of Bridge Clinics, a fertility clinic based in Lagos, Dr. Richardson Ajayi, also confirmed this view.
According to Ajayi, the commonest cause of infertility in our environment is infection. He said that when a man is infected, it could cause abnormality in the sperm and consequently affect his chances of fathering children.
Ashiru noted that, unfortunately, not many men are ready to join their wives when the need arises to seek treatment.
He disclosed that in the course of dealing with couples who have this problem, the result is faster when the men are cooperative.
Such was the experience of Kate and her husband. According to Kate, when the tests were done on her husband, it turned out that his stress level had increased so much, such that his fertility had been compromised. “He was placed on some drugs, which he had to take daily for a month,” Kate narrated.
Continuing, she said, “Kingsley found it difficult to adjust and he was always complaining that he couldn‘t continue to swallow what looked to him like the family planning drugs some women take. I had to encourage him, and within that month, I became pregnant again. That was after three years of trying for the second baby.” Now the couple has three male kids.
While the case of Kate and Kingsley ended on a rather good note, many couples have continued to grapple with the problem, sometimes resorting to spiritual means to solve a totally medical problem, with the attendant disruption of relationships and dissolution of marriages.
Ashiru, who is also the Editor-in-Chief of Reproductive Health magazine, said infertility has nothing to do with age, though a man‘s ability to achieve and sustain erection has so much to do with age.
According to him, as people get older, the testosterone level begins to decrease and therefore reduces their ability to have or sustain erection. The use of minerals and vitamins as well as male hormone replacement can help to resolve this problem.
Ashiru explained that there are several causes of male infertility, which can be categorised into four levels.
These refer to different anatomical parts of the man. They are the brain, the endocrine organs below the brain, the testis where the sperm is produced and the ducts that convey the sperm during ejaculation.
“In summary, the first level prone to major attack is the testis. This can be in the form of infection. One prominent infection is mumps. Mumps, during childhood in a boy, can lead to permanent testicular damage,” Ashiru explained.
Ashiru explained that male infertility can also be from embryological abnormalities during development. One of such is undescended testis. “Since sperm production has to be at a temperature slightly below body temperature, when the testis is left in the abdomen, it will affect sperm production and cause male infertility,” he said.
Experts are of the opinion that occupational and environmental hazards also play a major role in male infertility.
Corroborating the submission of an online health counselling web site, www.healthscout.com, Ashiru said, “We know that the following can be extremely toxic to sperm or prevent sperm production: pesticides, paint fumes, petrochemical and polyethylene products, crude oil fumes or its injections, plastic fumes, X-ray radiations; toxic effects of fumes from petrol generators, diesel generators and kerosene need to be evaluated. Lead fumes from bullets, welders and battery charger‘s fumes should also be examined.”
He counselled that workers in this type of occupation should wear appropriate protection masks to reduce the level of radiation that may result in infertility.
In the area of diet, he said, the use of artificial sweeteners can decrease sperm count, leading to infertility.
As for those men who love to use tight pants, or who sit on the hot driver seat in a trailer vehicle, the increased temperature occasioned by these activities can be toxic to the sperm, as the temperature can increase beyond the ideal one for sperm production, Ashiru said.
Also, smoking and alcohol consumption are said to be risk factors in male infertility. According to Ashiru, these two have been shown to destroy sperm cells significantly.
“If the sperm is very low,” Ashiru explained, “a man will have problem getting his wife pregnant unless they employ the assistance of modern reproductive technology. In this case, fertilisation is achieved manually in the lab in an IVF clinic.”
Once an examination of the sperm is done, Ashiru said, there are various treatment options, depending on the result of the sperm.