By Francis Kagolo
After getting a job as a banker, Moses lived a lavish lifestyle and his weight became a health concern. Three years of frequenting various saunas around Kampala have not helped him cut weight. Instead, his worries have increased; from being overweight, Moses is now uncertain whether he will ever have a child!
This follows a revelation by medical experts that saunas could cause infertility in men, a revelation to which Moses is trying to attest. “I have lived with my fiancé for the last one-and-a- half years. Even without using any family planning method, she is yet to conceive! Could I have a problem?” he wonders.
Yet Moses is not alone; for thousands of corporate and businessmen in Kampala, sauna and steam baths are a hobby.
What is a sauna?
A sauna is an unpainted, wood-paneled room with wooden platforms and a constant heater. The sauna emits dry air and a high temperature of over 80°C.
Many men and women go to the sauna after work or during leisure time for various reasons, including losing weight. One pays between sh5,000 and sh10,000 or more for a session of sauna, depending on the location.
Before getting into the small hot room where one sweats profusely, one is required to strip naked and wrap a small-sized cloth around the waist.
Some people go to saunas to pass time.
For instance, asked why he goes to the sauna, a man who identified himself as Jacob, he goes there to pass time as it helps him stay away from his quarrelsome wife at home.
Saunas and infertility
Both Dr. Collins Tusingwire, the assistant commissioner for reproductive health in the health ministry and Dr. Josephat Byamugisha, the head of gynaecology and obstetrics at Mulago Hospital, warns men against frequenting saunas, as this could cause infertility.
The Chinese Society of Obstetrics and Gynaecology director, Dr. Xu Deyi, in a recent online article titled Sauna Affect Male Fertility said that men who spend much time in a sauna environment are prone to dead sperm, weak sperm and other illnesses, which cause infertility.
How infertility comes about
Dr. Charles Kiggundu, a consultant gynaecologist and obstetrician at Mulago Hospital and Makerere University College of Health Sciences, explains that sitting for a long time in a sauna and steam bath exposes one’s genitals to excessive temperature, resulting in poor sperm development and ultimately, low sperm count.
According to Kiggundu, the gonads (testes) which produce sperm are hidden in the foetus’ abdomen during pregnancy. At birth, they come out and settle in the dangling scrotum.
“The scrotum has no fat and veins. This is to ensure that the testes are kept at a temperature lower than the normal body temperature,” explains Kiggundu.
High temperature, tight pants not conducive for sperm growth
While the normal body temperature is 37°C, the scrotum needs between 35.5°C and 36°C to operate normally. However, Kiggundu explains that the testes’ temperatures could rise if the scrotum is squeezed on the body for a long time, for instance due to tight pants or by exposing the testes to excessive heat like in saunas and steam baths
“The temperature in most Ugandan saunas can rise to over 45°C, which is disastrous to the scrotum and if sauna becomes a part of your lifestyle, it means that slowly, you are switching off the performance of your testes,” he expounds.
“A man needs one sperm to fertilise an egg, but if he lacks 20 million sperms per one millilitre, he will find problems impregnating a woman because the sperm count would be low.”
Besides reducing the amount of sperm produced, Kiggundu says, excessive sauna heat could also weaken the sperms. This hinders their movement as they would not be able to swim through the fallopian tubes to fertilise an egg.
“Some men tend to think that ejaculating alone is enough to cause pregnancy. But fertilisation does not occur at that exact point of the vagina where a penis ejaculates. The sperms must swim through the fallopian tubes to meet the eggs,” he emphasises.
“Imagine a situation where the sperms are few and weak! This means they cannot fertilise the female egg. So, you may ejaculate whenever you have sex, but no conception will take place.”
Abnormal weak sperms like those without a tail, those with large, small, tapered or crooked heads and sperms with curled or double tails are less likely to swim through the fallopian tubes to fertilise an egg.
Kiggundu says although there are natural causes and other factors that cause poor sperm shape, lifestyle changes and environmental pollution may escalate the problem.
Dr. Lawrence Kazibwe, an obstetrician at Mulago, concurs: “The testes are kept in a dangling sack (scrotum) because they are supposed to remain cooler than the rest of the body. The excessive heat in saunas would, therefore, destroy the quality of sperms.”
Saunas and sperm count
A 2001 scientific review on the Benefits and Risks of Sauna Bathing in Finland by researchers Minna Hannuksela and Samer Ellahham, says that most Finish men are not affected because they have high sperm count, but: “A few studies have reported decreased sperm count or decreased sperm movement after sauna bathing.”
“Besides the heat, there are other things going on in saunas like the chemicals used, alcohol abuse and smoking, which lower penis erection and fertility,” says Kiggundu.
Many people believe that a man is considered infertile when he is impotent. And traditionally, the women shouldered the blame if a couple failed to have children, but no wonder, Kiggundu adds, “only women would seek a solution from witch doctors and a few, from hospitals.
And, instead of informing their husbands, some women, especially in Buganda, would rather have sex with their brothers-in-law to get pregnant, if they discovered the problem was with their men.
Prevalence of infertility
More men are increasingly being diagnosed with male infertility. Although there are no specific national studies and statistics, pockets of data from individual doctors and clinics indicate an increase in the trends.
Kiggundu estimates that out of 100 couples who seek medical attention for infertility at Mulago Hospital, at least 40% to 43% are men. And low quality sperm tops the list of problems.
But this is not an isolated case. In France, the average sperm count fell by a third between 1989 and 2005, increasing their risk of infertility, according to a study of 26,600 Frenchmen published recently in the Journal of Human Reproduction. The number of normally shaped sperm fell by 33.4%.
Safer ways to lose weight
Kiggundu recommends jogging and other exercises if one wants to lose weight. But if one cannot do without the sauna, he should at least ensure that he does not visit it routinely, or that each sauna time does not exceed 15 minutes. It is also advisable to leave the sauna immediately one feels dizzy, drowsy and physical discomfort.
Why is there sperm shortage?
In the 15 years between 1989 and 2005, according to a study recently published in the journal Human Reproduction, the sperm count of French men fell by one third.
More than 26,000 men were tested in the study, and the number of millions of spermatozoa per millilitre of their semen was falling by almost 2% a year. If that rate of decline has been maintained since the study ended, the count will be down another 13% by now.
Admittedly, counting sperm is tricky. You can fit 100 million of sperm into a teaspoon; they all look alike, and they keep wriggling around. But these results are being taken very seriously because they don’t have the usual defects of this sort of study.
Most studies on sperm counts use data from men who donate sperm for artificial insemination centres (who are chosen for their high fertility), and/or from couples who are having trouble conceiving (which may be due to an abnormally low sperm count in the male partner). In neither case is it a genuinely representative sample.
The virtue of the French study is that the country has the Fivnat database, a record of some 440,000 cases of infertility problems at 126 government-funded “assisted fertilisation centres” from the 1980s onwards.
The researchers chose only the 26,200 cases where the problem had proved to be complete sterility in the female partner, which presumably meant that their male partners were a random sample of the population.
Treatment for infertility is free in France, so there should be no income bias in the data either. For those reasons it is probably the most reliable survey of changing sperm counts over time that has ever been done, and it documents a steep fall in a relatively short time.
The numbers are impressive: From 73.6 million sperm per millilitre in 1989 to only 49.9 million per millilitre in 2005. If the rate of decline has stayed the same since 2005, the number now would be around 43 million.
Doctors generally regard 15 million as the number, below which there will be serious problems with fertility, so there’s another 40 years or so before the problem gets really serious.
There are really three questions here; is the same thing happening elsewhere? What’s causing it? And how much does it matter?
Most other scientific studies in developed countries in the past 20 years have also found falling sperm counts, though none of them matched the French one in scale and precision. There is no comparable research on the trend in developing countries, but it is at least plausible that this may be a global phenomenon.
That mostly depends on what is causing it. If it is environmental factors, are they the same in rich countries and poor ones? A common theory lays the blame on chemicals in the environment like Bisphenol A, found in some plastics that disrupt endocrine function and change hormonal balances.
Another theory blames smoking, drinking alcohol, and high-fat diets. These factors vary from one country to another, and more research is clearly needed.
Adopted from columnist Gwynne Dyer’s previous article
Dos and Dont’s
People with a history of hypertension and heart disease are discouraged from going to the sauna.
Avoid tea and coffee immediately you leave the sauna because they further dehydrate the body. In addition, coffee and medications with caffeine may make sperm sluggish.
Drink water at room temperature to hydrate and cool the body.
Avoid alcohol, smoking and drug abuse because they compromise the strength of a man’s erection and fertility, lower sperm count and slow down sperm mobility. Do not smoke to prevent infertility.
Bathe cold water and avoid hot baths. Men are advised to avoid frequent use of hot tubs. Frequent use can lower sperm count by overheating sperm-production cells, especially at high temperatures.
Reduce fat intake and eat fruits including carrots, papaws and oranges because they are rich in Vitamin C which helps remove toxins from the body.
Exercise frequently to boost blood circulation
Wearing tight trousers or underwear may overheat the testicles, affecting the sperm-producing cells, thus lowering sperm count. Wear loose-fitting underwear and if possible, sleep naked.
Sexually transmitted diseases can have an adverse effect on fertility. Get tested for sexually transmitted diseases.
Avoid sitting for long, particularly on seats that are not well cushioned, for instance the kameme. Long distance drivers should be more cautious, as this predisposes one to infertility due to the high temperatures.