Ugandan men freezing their sperm at $500 dollars per year

For clinical reasons which may lead to low sperm count, some young Ugandan men are choosing to freeze their sperm for a later date. But just how long a man can wait to have a baby, Carol Natukunda reports

A man is diagnosed with a deadly illness. He has to undergo treatment for several months. But there is a lot at stake. He will lose his sperm count. The quick solution? He decides to deposit his sperm at a semen bank where they are frozen.
Ugandan men are waking up to the fear that they might not be able to have children when they want them. As such, they freeze their sperm for future use.

Years ago, it was unheard of. However, with technology advances, manhood has been redefined.

Morris Eluga, an embryologist of the International and Fertility Hospital in Bukoto says every month they receive an average of five to six Ugandan men seeking to freeze their sperm. That’s an average of 60- 70 men every year at this fertility center.

Sunday Vision could not independently verify whether other clinics are doing the same. Other fertility centers such as Kampala Independent Hospital in Ntinda and Life Link in Kamwokya said they were only doing sperm donation.  

Eluga stresses that a man’s reasons for freezing his sperm are largely clinical.

This includes when a man is facing medical treatment for a condition such as cancer or is about to have a vasectomy – a family planning method that may stop a man from having more children. That is a man’s greatest fear.

“The cancer treatments such as chemotherapy and radiotherapy, for instance have adverse effects on one’s sexual life, sperm count and general health, and if one has been diagnosed with cancer, they choose to freeze their sperm first,” explains Eluga.

Factors such as lack of exercise, poor dieting, wearing tight trousers and sitting for a long time, have all increasingly been associated with low sperm count.

“You just cannot be sure that you are going to have children when you want them. That’s a man’s greatest fear. We are in society where manhood is defined by the ability to have sex and have children.”

explains Eluga
 “The men freeze their sperm in case of eventualities.  But in most cases if a woman has to freeze their egg for future use, the women are dealing with a lot of pressure to do with their careers and the biological clock ticking,” he says.

Kyeyo men also freeze sperm
Eluga explains that some men going for further studies, or those who have got high paying jobs in war torn regions like Somalia, Iraq and South Sudan are also freezing their sperm.

“Because the regions are risky and sometimes the intensity of the jobs doesn’t allow them to come back too often, they are afraid of not leaving any offspring in case they die there. They just don’t want to die with their sperm. They leave it to be donated to a woman who needs it,” explains Eluga.

“Sometimes, a man is going to Sweden for two to three years, and leaving his wife behind. His budget does not allow him take his family along. He is not sure when he will be coming back. And yet, he wants to have more children when he is away. What can you do? Freeze semen with us and then when his wife feels like she wants to have her next child, she can come here and we give her his sperm, through In vitro fertilization,” Eluga explains.

The cost
At the Bukoto fertility center, the cost of freezing sperm is 500 dollars (sh1.5m) annually. Details of how much it would cost to extract and freeze an egg are scanty. But Sunday Vision has learnt that is an expensive venture and Ugandan women have not yet embraced it. In the developed countries it costs between 1,000 dollars to 4,000 dollars.

Eluga acknowledges that for a woman to freeze an egg it is an intricate procedure. “When you are handling an egg, there are elements in the egg that should stay the way they are.   You tamper with it even slightly, it dies. And every month, a woman produces just one egg. So if you want to harvest say, five eggs at ago, you have to induce them artificially. Still, not all eggs recover,” he explains, adding that egg freezing is a luxury for the upmarket and elite women.

Process of sperm freezing
Before one agrees to freeze the sperm, the expert will explain the process involved. One would also be screened for infectious diseases, including HIV. A written consent and agreement detailing his background, and for whom the sperm is to be stored is also signed. Inside the lab, one has to produce a fresh sample of sperm, which will then be frozen and stored in a bank. The process of collecting and sperm freezing could only take 10 to 15 minutes, while egg freezing takes about 40 days, including body preparation.

Inside the sperm bank
In a tiny room inside the IVF lab at the fertility clinic, Sunday Vision is greeted with four tanks which look like your typical gas cylinders. “This is where the sperm is stored,” says Eluga.

He slowly lifts the lid from one of the tanks, there are multi coloured tubes which look like straws. “Each sample of semen is stored separately. We have enough capacity to for storage,” he says.

While he is hesitant to go into specifics, he says each tank contains nitrogen.

“We don’t rely on power. We use nitrogen to freeze them. At -300 degrees, the coldness is the same coldness you find on the moon. If you put your hand inside there, it could turn into ash. A cold burn is worse than a hot burn,” explains Eluga.

Nearby, are other tanks holding embryos which are ready to be used in the IVF. “We can also freeze their embryos for the women who already have partners, but do not want to give birth now,” he says.

Although the maximum time the sperm can be frozen is over 10 years, Eluga warns that one shouldn’t be 100 sure that it would work when the time comes.

“Technology keeps changing so the freezing system also keeps changing, so you can’t be sure that you will keep the same result you would have ten years ago,” says Eluga.

A man’s biological clock
Pursuing education and career, a lot of men delay their first birth. In economists, it is a good development. “This is good for generating high quality population with high demographic dividend,” says Prof Augustus Nuwagaba, an economics expert.
However, such men are silently battling with their biological clock.

“I am doing my masters degree and want to marry when I have built and achieved a lot of savings. But what if by the time I settle down; I have a low sperm count and cannot have children? What if I have to die now and I have no child?” asks a 35-year-old lawyer.

His worries are not far from reality. Infertility appears to be a growing problem among men in Uganda.

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 Bugolobi also revealed that of the 100 people that will seek fertility treatment at the hospital, 40 of them are men. Another 40 are woman and the remaining 20 are usually either women or men.

Dr. Patel Prakash, the gynecologist at the endoscopy fertility center notes that male fertility declines such as smoking, alcohol and lack of exercise, coupled with a sedentary lifestyle.

“You have people who are feeding on junk yet sitting for longer hours. The other is untreated or incompletely treated STDs,’ he says, adding that sometimes it could be genetic or certain medications.

It has always been believed that men could continue to father children well into their old age. But a 2012 research by a team of scientists from America's University of California discovered that men also have a biological clock. Just like women, their fertility decreases with age. The research reveals that the quality of men's semen declines as they get older.

Researchers found that sperm became slower, making it less likely to reach and fertilize an egg.

They also discovered that the older men get the less semen they produced. For example, a 50-year-old man produced 20 per cent less semen than a 30-year-old man.

Although men may have a biological clock, it does not start ticking as fast as women's. Women’s fertility was found to begin declining in her early thirties and then dropping rapidly between the ages of 35 and 40.

However, men do not reach a 'threshold' of sudden decline when they hit a certain age. Dr Brenda Eskanazi, one of the lead researchers, said, 'It is more a gradual change over time.'

Local doctors agree that age could limit a man’s ability to have a baby.
“Older men experience changes in their testes which could have an impact on the quality of sperm. Older men may still father children but on average it will take them longer to do it,” says Dr. Cryspus  Juuko, a doctor in private practice.

Doctors appeal to men to change their lifestyles. But just like women, we have a biological clock too. “Men aren't excused from reproductive ageing.  Couples should recognise that having children in their 20s and early 30s time matters a lot because that is when they are most fertile. That makes the difference between an easy conception in the bedroom and expensive fertility treatment in a clinic,” says Juuko.

What the government says on egg/sperm freezing
Dr. Chris Baryomunsi, the health state minister in charge of general duties says the government welcomes the developments. “We welcome the technology because infertility is one of the challenges among couples. It gives hope to people who are childless,” says Baryomunsi.

As it is, there is no law to guide the new developments that have come with IVF.

He reveals that they will soon be drafting a law to guide the operations of fertility clinics, the In-vitro fertilization, surrogacy motherhood, sperm, sperm and embryo freezing among others.

“We are coming up with a statutory instrument to guide these processes. After that it will help us to formulate a policy,” says Baryomunsi.