• According to the European Science Foundation at least one in five men aged 18 to 25 is sub-fertile
  

By Caroline Ariba

A two week infertility clinic was held in Uganda by Saint Francis Mutolere Mission Hospital in Kisoro district and Albert Einstein School of Medicine in New York.

For the longest time, most of Africa’s infertility was deemed secondary and largely so, due to tubal factors. So the International Federation of Fertility Societies in conjunction with The American Society for Reproductive Medicine sought to find if there were any changes over time.

Randomly, Kisoro district was chosen as the place of study. Whilst there, 85 men’s semen was tested, and of these, 33 had abnormal semen while 9 men did not have a single sperm in their ejaculate.

This confirmed that infertility in Uganda, which is an African country, was not only from the tubal blockages but from poor quality sperm. This meant that slightly over 10% of the men at that place, at that given time could not get a woman pregnant, not naturally at least.

In a previous interview with the New Vision, Dr. Charles Kiggundu, a consultant gynecologist at Mulago said that of the 100 patients that seek fertility treatment at the Hospital at least 43 are men.Top on the list of those seeking this treatment is low quality sperm.

 Dr. Jamal Abduo, a fertility expert at the paragon hospital in Bugolobialso says that of the 100 people that will seek fertility treatment at the hospital, 40 of them are men. Another 40 arewoman and the remaining 20are usually either women or men.

Last year, Mulago hospital’s fertility and prenatal clinics revealed that that of every three infertile women that visited, two were more likely to be threatened at home. And at least one was more likely to be the victim of physical violence inflicted by their intimate partner.

Sadly, the men do not know that infertility could be from either the male or female factor, a study by Mulago hospital revealed this.

Of the 83 men spoken to, 82 said that they did know that three of the main causes of childlessness could have a lot to do with a man.

So today, fertility and family balancing expert Dr. James Olobo Lalobo explores the issues on poor quality sperm and male infertility.

Sperm quality threatened

For a long time, infertility has been thought to be a problem of women only. However, men can also be infertile. Fertility specialists have also discovered that sperm numbers and quality have declined worldwide.

At Paragon Fertility Centre, there is more demand for sperm washing to isolate the perfect sperm to do in-vitro fertilisation (IVF). For a long time, Ugandan men fathered children from high quality sperm way into their 80s.

Today, however, the egg, that is the target, is not easily reached by youthful men’s sperm. This leaves many wondering, why are today’s young men, the world over, whether rural or urban, on a rocky path to becoming infertile?

What are sperms?

Sperms are the male reproductive cells responsible for fertilising a woman’s ova (eggs) to form a baby. To do this, a sperm needs to be of good quality and a fast ‘swimmer’ so that when released, it swims fastest to the ova.

A healthy male will discharge about 50 million sperms in a single ejaculation. Of these, only a few hundreds will make it to the ripe ova where a single winner will fertilise it. To be able to fertilise, a sperm needs to have a focused single head that shoots ahead to win the competition.

Sadly, today, many young man, who should be at the peak of their health with high quality sperm,  are releasing funny looking, double-headed, double-tailed, big headed or seemingly good looking, yet slow sperms.

When released, such sperms almost never reach the target (the ova) and this could explain why it takes many men long to make a woman pregnant. The European Science Foundation issued an ominous report warning that at least one in five
men aged 18 to 25 is sub-fertile.

As a result of the declining sperm count among men over the years, the World Health Organisation had to revise downwards the level of sperm count able to fertilise the egg from 40 million sperms per millilitre to 15 million per millilitre.

However, the situation in Uganda is such that visits to fertility clinics are almost never done by men who mostly prefer to live in denial and blame women. However, this is worrying because half the time I treat an infertile couple, the man is the one who needs the treatment.

Most men assume, wrongly, that because they can sustain an erection and are capable of penetrative sex, their sperm production must be okay.

Sadly, this very self-assured position is far from the truth. In terms of reproduction, the macho pause is a bluff.

Causes of poor quality sperm in young men

true

Men should not be quick to blame women if they cannot get children

When asked about the causes of poor quality sperms and, thus, infertility among young men today, Dr. Lalobo says the answer lies in modernity. He says nearly everything about modernity has affected the quality of sperms. These include;

Alcohol

Alcohol, especially when taken in plenty can damage the quality, structure and movement of sperm. This is because alcohol stops the liver from properly metabolising vitamin A, which is needed for sperm development.

In Uganda, the problem of overconsumption  of alcohol started with the previous generation (the post-independence generation) and has become worse with today’s generation.

Therefore, today’s sperm producers were “hit” whilst still in the womb and are now living in an even more contaminated world. Car engines, hot tubs and saunas Day in and day out, working men (and even women) spend time stuck in a car because of traffic jam.

What should be noted is that the heat of an engine is tough enough to destroy sensitive cells in the body. Heat decreases sperm production and, thus lowers sperm count. Even when sperms are manufactured under such conditions, chances are high that they are weakened or damaged.

Environmental toxins

Veterinary doctors know that a bull is renowned for its exceptionally high volumes of quality sperm production.  However, studies done in the US on animals living in an environment polluted by bisphenol–A (BPA), which is like oestrogen (a female hormone), showed significant levels of sunk useless penises in the animals.

Today’s man lives in a  similar environment — heavily polluted.

In the womb

The masculinising programming zone (MPZ) is recognised as a vulnerable period in the development of the male reproductive organ as a baby boy grows in its mother’s womb. This is when the capacity for sperm production is programmed. This is sometimes affected by heavy alcohol consumption by the mother, which affects the proper formation of a child in the womb.

Infections

An infection in the genitals, such as chlamydia or gonorrhoea could cause infertility. These can cause a structural blockage of the male genital tract. For example, the sperm duct, which carries sperm can be damaged by infection or even injury. Surgery to the scrotum and surrounding areas could also cause such a problem.

Medication

Certain medications, like testosterone replacement therapy, anabolic steroids, cancer drugs, some antibiotics and some
ulcer medications could cause infertility.

Even worse, there is a lot of exposure to dietary additives, pesticides, industrial pollutants that hinder sperm production.

Hormones

There is a condition called hypogonadism, where the testes produce few or no hormones needed for normal sperm production.

Genetic issues

Certain genetic conditions such as Klinefelter’s syndrome, where a man is born with an extra female chromosome, which
makes his male side somewhat dormant.

Undescended testicles

Mal or undescended testes also inhibit sperm production.

Hypospadias

This is a condition where the penis is short, and curved or crooked, with an abnormally placed urethral opening. Sometimes, this prevents the sperms from swimming out.

Varicocele

Varicocele refers to the enlargement of veins within the scrotum. This can cause the testicles to shrink and affect sperm production, thus causing infertility.

Self-attack

Sometimes, antibodies attack the sperms, mistaking them for harmful invaders and attempt to kill them.

What is the way forward?

For men who think they could be infertile, Dr. Lalobo advises them to;

* Start by changing your mindset and overcoming the fear.

* Get examined by a doctor, for example you could do a sperm analysis, to establish the cause of your issue. In 30% to 40% of the cases, the problem originates from the testes. However, in 40% to 50% of the cases, there may be no known cause. In both situations, treatment is guided by the sperm analysis.

* After the examinations, you will be started on the right treatment fit for your diagnosis. During treatment, you need to be open to your doctor and your wife.

* If the problem is that the sperms are few, abnormally formed or generally weak, then sperm washing could be recommended. Here the sperms are sorted to get good ones that are used to artificially inseminate the wife.

Alternatively, the woman’s ova can be harvested and fertilised in the lab with the washed sperm after which the embryo is implanted into her uterus. The process can be done through the conventional in-vitro fertilisation or can be combined with intracytoplasmic sperm injection (ICSI).

*There is a 10-20% chance that the pathway is blocked. In such a case, it can either be unclogged by surgery or by-passed by precision microsurgical techniques, to retrieve sperm. The sperm is then used in the combined process of IVF and ICSI. A single retrieved sperm may be all that is needed for the treatment.

* In about 2% of the cases I have done such operations, I have discovered that the problem was with the pituitary gland or what many call the “fuel deport” for sperm production. In such cases, hormonal replacement tablets or injections may be given.

* In less than 1% of the cases, the problem has been due to sperm-destroying antibodies. In such cases sperm washing and intra-uterine insemination is the appropriate treatment.

* If no sperm can be retrieved surgically, then the solution is to use donor sperm for the wife to get pregnant. If this fails, the couple is encouraged to adopt children or accept to live without children.