I was born with congenital absence of the ejaculatory duct. Of course my parents did not know this at my birth; neither did I or anyone else realize this as I was growing up. The disease is not something one can see visibly on the face like a cleft lip or on the body like two thumbs or even by doing blood tests to screen for malaria or cancer. It is just there, something one is born with that doesn’t affect the quality of one’s life, until you get married and want to get your wife pregnant and you can’t.
I married Cecelia who was a beautiful girl eleven years my junior in 1989. We were married for three years without getting pregnant. We finally made the reluctant decision to visit an infertility clinic in England. They did several tests on both Cecelia and myself. And found that Cecelia really had no problems getting pregnant. The problem was with me. The first test they did required my giving them a sample of my sperm. They performed a seminal fluid analysis on it and discovered that there were no sperm cells in my semen. This is called azospermia in medical talk. The complete absence of any sperm in the ejaculate is caused either by some obstruction in the testis or congenital absence of the Vas Deferens. The Vas Deferens are the ducts that carry the semen from where they are made in the testes to the ejaculatory duct. To rule out the possibility of my having congenital disease, the doctors in London said they wanted to do further tests on me using an Ultra Sound Scan. The results of the scan showed that I did have Congenital Absence of the Vas Deferens. What does that mean I thought to myself? Apparently I was born with abnormal positioning of the sperm passage called congenital absence of the ejaculatory duct. The sperm ejaculation goes into the bladder rather than the ejaculatory duct where they can be passed into the penis. This they called ‘retrograde ejaculation’ when all or part of the sperm goes into the bladder instead of the ejaculatory ducts.
The diagnosis was that I, and not my wife was infertile because I had no sperm in my ejaculate because the passage or duct that carries the sperm into the penis is absent and instead of going into the penis , it goes into the bladder. Some men get this abnormal positioning of the ejaculatory duct after they undergo surgeries on their prostrate, but in my case, I was born with it. In short, I did have sperm, but the sperm was all going into my bladder, instead of into the penis where it could be delivered into my wife’s womb to get her pregnant. I cowered in shock, disbelief and dismay as the London clinic delivered the verdict that I could not father a child and removed all hope of my wife and I having children together because Congenital Absence of the Vas Deferens was simply not treatable by the available technology at that time. It was a congenital problem and I was told that approximately 2.1 to 8.9 percent of infertile men had a genetic component of their infertility.
I was very lucky because my wife was extremely patient and loving. She simply refused to give up hope. We thought of her doing artificial insemination with donor sperm where another man’s sperm would be used to fertilize her, but she absolutely refused. Somehow she just believed that one day an Assisted Reproductive / Conception Technique (ART) would be available for women to make it possible for me to father a child with my own sperm and we could be a complete family.
Her strong faith kept us going during those despairing times and eventually our prayers were answered. In 1998 she was told about some Assisted Conception Technique to treat male infertility, they work by allowing sperm to bypass various barriers that are causing the infertility. For example trapped sperm can be extracted with special needles either direct from the testis by a procedure called Testicular Sperm Extraction (TESE) or the Epididymis which is the coiled tubes outside the testes where the sperms collect in a man that has no ejaculate ducts. The sperm can also be aspirated in which case it is called TESA. Other similar techniques are called Percutaneous Epididymal Sperm Aspiration (PESA) or Microsurgical Epididymal Sperm Aspiration (MESA). The collected sperm will be frozen and stored for later use and fertilized and implanted back into the woman using another technique called ICSI. Cecelia came home that day from visiting her friend so excited and bright eyed to tell me all about these new wonder techniques. IVF had been discovered decades ago to give hope to women who had blocked tubes but who had ovaries. These techniques would help men who had sperms, but had blockages in the Vans Deferens which are tubes carrying the sperm to the testis.
The problem was at that time the few clinics and doctors’ that knew how to do this technique were in the United States. We were told by a good friend of one Nigerian Doctor who was based in Chicago who might be able to link us with a centre in the U.S that did the procedure. The doctor frequently came to Nigeria and consulted with his Nigerian patients at his clinic called Medical Art Centre (MART). We went to his clinic and were given his phone number in Chicago. On phoning him we heard the unbelievable miracle we had been waiting to hear. “Yes!” said Prof. he and a colleague at the University of Illinois in Chicago were doing the TESA technique. He told us when he was coming to Nigeria next and we waited anxiously for his return.
When he finally arrived in Lagos he performed further tests on both Cecelia and myself and confirmed the diagnosis I had received in London; that I had Congenital Absence of the Vas Deferens. He also found that both Cecelia and I had some other endocrine abnormalities, which had to be corrected before TESA treatment could be performed. Cecelia had high prolactin and he gave her drugs to bring the levels of this hormone to normal ranges. He also gave me hormones to increase my sperm production. Prof. also gave me detailed lifestyle counseling which were all designed to enhance the quality and quantity of my sperm count.
Prof put me on a low carbohydrate diet and gave me other diet recommendations to enhance the quality of my diet as he told me that the quality of my diet could have an adverse effect on male fertility. If one is not eating a proper balanced diet, the body is not getting the nutrients that it needs to engage in sperm production. He also gave me supplements such as zinc, vitamin B12, and vitamin C to produce healthy, viable sperm. Many men with nutritional deficiencies suffer from low sperm count as a result of their poor diet.
He advised me to lose weight, as I must admit I was rather portly especially round the middle. He educated me on how too much weight can also have a negative effect on male fertility and sperm production. He told me that many studies show that men with higher-than-normal body mass index (BMI) are more likely to suffer from fertility issues. This is because weight influences how the body produces certain hormones. For example men who were overweight produced 24% less testosterone than men of average weight and obese men produced 26% less testosterone. Sufficient levels of testosterone are needed to produce high levels of motile sperm.
I was naturally told not to touch any alcohol or cigarettes. Even moderate amounts of alcohol can lead to weaker and slower sperms compared with non-drinkers and heavy alcohol consumption is linked with reduced sperm count and poor sperm motility.
In the case of cigarette he told me to avoid areas where people were smoking as second-hand smoke has been shown to reduce sperm count in men, and can also affect sperm morphology which is the shape of the sperm cells. I was naturally to avoid any”recreational drugs” like Marijuana, Cocaine, amphetamines, PCP, and heroin as they play a big role in male factor infertility. Their use has been associated with low levels of testosterone and appears to affect sperm quality. Some of the drugs have also been linked to reduced sex drive, erectile dysfunction, and ejaculation problems. Anabolic steroids cause hormonal changes within the body, and can severely reduce sperm count and production. He also cautioned me to avoid chemicals and toxins especially many house cleaning and insecticides and pesticides products we use around the home and gardens.
I was to avoid being stressed as physical and emotional stress can also play a role in male factor infertility. He told me that stress causes the body to release certain hormones. Continued stress can cause hormonal imbalance, which could affect my sperm production.
He put me on regular but not over strenuous exercise. He told me that it was advisable to avoid vigorous training programs, but that regular and moderate exercise helps maintain a healthy body weight, helps control stress, and gives a healthier overall body. He taught me a number of relaxation exercises to do since infertility and life in general can be stressful, and it is important to learn to relax.
I was to avoid hot tubs, saunas and tight under wear, since they raise the body temperature and can reduce sperm count.
Finally I was put on some medication to tighten the bladder neck for my retrograde ejaculation.
Finally the day dawned when I was to undergo the TESA treatment. We had to travel to Chigago to do this. We met Prof’s lovely family who entertained us very graciously at their beautiful home outside Chicago. We had many dinners in their home during our stay in Chicago for the various treatments, which took a total of 12 months. Getting to know his family made us feel very comfortable with the treatments. We had no family or friends in Chicago; Prof’s family became our family and only friend so far away from home. Prof’s wife spent many hours talking and counseling Cecelia assuring her that the treatments will be a success and giving her hope and confidence.
The day finally dawned. I checked into the hospital the day before the procedure with Cecelia holding my hand. We were both nervous and scared. Could I turn back? Only the disappointment in face kept me glued to the stretcher as they wheeled me into the operating theatre. After all her patience and love I could not disappoint her. I gritted my teeth and allowed them to give me the anesthesia. Before I knew it I was awake again and recovering in my room. Prof came in smiling. He told me that they had been able to get a number of good sperm cells from my epididymus, which they would freeze and store until later when Cecelia was ready for the ICSI procedure.
After a few months Cecelia was asked to return for ICSI. ICSI is Intracytoplasma Sperm Injection. She was first given drugs so that she would produce as many eggs as possible. Then her eggs were removed from her ovaries using laparoscope. Many eggs were removed then these eggs were injected with a special needle under a magnifying microscope. My sperms were then introduced into the cytoplasm of the eggs to fertilize them. Four of her eggs fertilized. After a few days three of the four eggs were transferred back into her womb.
We waited anxiously until it was confirmed she was pregnant. With joy and gratitude to God we received our baby son