Parenthood is believed to be one of the most exciting moments in the lives of married couples. However, infertility remains a threat to most married couples who dream of someday becoming parents themselves.
It is a global health issue affecting millions of people who have attained reproductive age. Infertility can affect both men and women and is usually self-diagnosable by the inability to get pregnant.
Despite rising cases of male infertility globally, focus is almost always on the woman whenever issues of infertility rear their heads in a union, particularly in African settings.
Dr. Abayomi Ajayi, a renown Gynecologist, fertility expert and founder, Nordica Fibroids Care Centre, a leading fertility clinic in Nigeria, defines male infertility as; “A Situation where the man is either wholly or partly responsible for infertility in a union, and it’s so common that we think that it accounts for about 40 to 60 percent of the cases today’’.
Speaking further, Dr. Abayomi says;
“The only way we can roughly assess male infertility now is by looking at sperm analyses. And it seems that for whatever reasons, the sperm parameters are declining all over the world.
“There was a study done in Europe and America that showed that in about forty years, sperm count had declined by about fifty percent. We also did some in Nigeria and we saw that in about ten years, we had a decline of about thirty percent. So, there is no doubt that sperm count is becoming a rare commodity. Hopefully, science will be able to answer that question over time, to bail the men out’’.
Lifestyle
And while efforts to clearly understand the situation concerning sperm count decline remain on course globally, there are nevertheless sufficient scientific evidence pointing at lifestyle as one of the major causes of male infertility.
Dr. Abayomi Ajayi puts it thus:
There are so many things we think are responsible; with lifestyle being a major thing. Though we know that lifestyle is probably also the only reversible cause or main factor in male infertility. And some also have had infections and it knocked off the tube that connects where the sperm is made in the testis to where it’s needed in the urethra. And so that vase is blocked from previous infections when not well treated.
“Another infection we need to look at is Mumps, because we’ve seen that for guys who have had Mumps especially as teenagers; about forty percent of them have some derangement in their sperm count. Another thing that you can be born with, of course is undescended testis; when the testis of a boy does not descend into the scrotal sac. What we do is that we must fix it before school age.’’
Speaking further on male factor infertility, Dr. Ajayi says;
“Alcohol, hard drugs, like the ones used for testosterone; might also increase the risk of male infertility. Then of course there are some vocations also that can be destructive to sperm count. We did a study even in Nigeria…..we looked at the three clinics that we have and we saw that male infertility is common in the Niger Delta due to environmental pollution, than in other parts of the country.
“So, there are jobs that can also predispose men, like if you work in a fuel station for a very long time, a paint industry, or motorcycle riders because they subject their testis to high temperature for a very long time. Putting your phones in your pocket and wearing nylon underwear. That’s why God made the testes to be outside the body, to enjoy fresh air. So if you go and make it so hot over a long period of time, you increase the risk factors. So…those are some of the factors,” he added.
Treatment
Since the advent of Assisted Reproductive Technology (ART) over four decades ago, with accompanying technological advancements in the years thereafter, infertility treatment has improved significantly. Importantly, one of the first steps towards getting treatment for male infertility is by subjecting a patient’s sperm sample for laboratory investigation.
This process enables the medical expert to examine the sperm cells in order to determine the number, the density, the motility, volume, white blood cells and the morphology.
In the final analyses, if the sperm sample cells fall short of the minimum standard of 15 million cells set by the World Health Organization, WHO, the person obviously has issues of male infertility.
Dr. Abayomi Ajayi explains why fifteen million is now considered an acceptable parameter by the WHO;
“The World Health Organization is aware that sperm count is reducing, so they have also been shifting their goal posts. We started with forty million, we came to twenty million and now it’s fifteen million. Fifteen million is considered to be normal. Other procedures aimed at unraveling male factor infertility include DNA fragmentation Index, DFI. Therefore, a high DFI in any man is an obvious red flag! Furthermore, age and obesity are factors that predispose men to male infertility.”
In treating male infertility, Dr. Abayomi argues that contrary to popular belief, drugs do not provide solutions to most cases of male infertility. He however recommends In Vitro Fertilization, IVF, with either the Intracytoplasmic sperm injection (ICSI), or the Intracytoplasmic morphologically selected sperm injection (IMSI) varieties of IVF.
According to him; “The difference between ICSI and IMSI is simple: with ICSI we want to choose the sperm that we think are normal. So, the only way we were doing that was to magnify to about two hundred and see the sperms that can move, and use them to fertilize. But when we saw the miscarriages from that, then we said no. We were clearly using some sperms that normally will not fertilize, to fertilize.
“That’s how IMSI came in. Now with IMSI, we magnify to about six thousand, so we can really see the sperm not just because it can move; we can see the head, the neck and the tail of the sperm. What we saw then was amazing! Some of the sperms that could move also had some funny things. Some of them had holes in their heads, some had problems in their necks and others, their tails were not okay. So we started using IMSI to choose the sperms.’’
In all of this, it is important to emphasize that the most important thing in the treatment of male infertility is not just the quality of the sperm, but the DNA it carries. This, along with the right proportion of protein it has, is what makes a near-perfect sperm which fertilizes the eggs. It is true that the challenges of infertility can be overwhelming, but when couples support each other throughout the ordeal, things get better. After all, it takes two to tango and it also takes two to have a successful treatment!
