Mr and Mrs OJ are a pleasant couple I was privileged to attend to a couple of years ago. They had been married for 13 years and though they had an eleven-year-old son, they wanted more children. Mrs OJ had visited every specialist in town and quite a few prayer houses too. She saw our TV programme and called to book an appointment. After a brief chat with her, I discovered that though her husband had been very supportive financially, funding her doctor’s visits, he had never joined her in doing any of the tests. After all, he had impregnated her effortlessly twelve years before and he could have three rounds of sex in a row, so nothing could be possibly wrong with him or so he thought.
I carefully explained to her that while it is possible that nothing was wrong with her husband, it was simply merely an assumption until he undergoes medical tests. I therefore advised Mrs OJ to speak to her husband about having a sperm test done.
Mr OJ, a 44-year-old school proprietor, felt slightly embarrassed when it was suggested to him to have a semen analysis done. However, he insisted he was tired of running from pillar to post and just wanted to get to the bottom of whatever was responsible for the delay in conception.
So, an answer-seeking Mr OJ took the sperm test after three days of abstinence but the result was very shocking. Not only did Mr OJ have a low sperm count, the sperm motility, which is the ability of his sperm to swim from the vagina, where it is deposited, to fertilize an egg was also very poor!
Those two factors have had a significant negative impact on the couple’s conception rates over the years. “What could have caused this?” A bewildered Mr OJ asked me? “It’s difficult to tell exactly what caused this or when it happened” I replied. Sometimes in medicine, the question to ask is not “how a condition came about?”, as we may never be able to tell. But, the question which we must engross ourselves with as professionals is, “how do we correct such conditions?”
When sperm count is low, the ability of sperm cells to fertilize the partner’s eggs is also reduced. A man’s sperm count is considered lower than normal if he has fewer than 15 million sperm per milliliter of semen ejaculated.
Having a low sperm count decreases the odds that one of a man’s sperm cell will fertilize his partner’s egg to result into pregnancy. Nonetheless, many men who have low sperm counts may be able to father children. With assisted fertility techniques, there are several approaches to achieve conception when a man has a low sperm count, but what offers the best chance of success is a special type of assisted conception referred to as intra cytoplasmic sperm injection (ICSI ).
Understanding the ICSI procedure
In this procedure, a woman’s ovaries are stimulated to produce multiple eggs. The eggs are then collected and fertilized with her husband’s sperms using special instruments. The developing embryos are cultured for a few days in the laboratory before carefully returning them back into the womb of the mother.
That was exactly what I advised Mr and Mrs OJ to do and they consented. After the procedure, they became parents of a set of twins about nine months later.
The days of infertility being considered a ‘woman’s problem’ are long gone. As we now know that there may be infertility due to the man (male factor infertility) or due to the woman (female factor infertility). About 35 per cent of couples have fertility challenges due to male factors , another 35 per cent due to female factors, 20 per cent due to both and the last 10 per cent due to unexplainable factors.
Recent findings show that male factor infertility is on the increase. A European study showed that one in four men in the age range of 21 to 45 years have low sperm counts. Male infertility is typically revealed after a sperm analysis is conducted. This involves examining the semen sample for sperm cells which are then characterized in terms of number, ability to swim, appearance and other factors.
Common causes of male factor infertility
- Infections
A simple childhood infection such as mumps which causes pain in the jaw area and associated fever for a few days may spread to the testis of a boy and lead to testicular mumps; this infection may damage the testis and cause infertility in later life. Other infections especially sexually transmitted infections such as gonnorhea, chlamydia and others, may also lead to infertility. This is especially so when it is untreated or poorly treated
- Testicular injury
The testis is a rather sensitive organ and any sudden impact with a solid surface will cause severe pain. This may occur during sporting activities, when jumping on a bicycle or motorbike or during accidents. One of the commonest injuries we see happens when the testis becomes twisted and this cuts off its blood supply known as torsioned testis. If this is not corrected within six hours, the injury to the testis is irreversible and will invariably lead to low sperm count.
- Anatomical abnormalities
Some boys are born with their testis in the lower abdomen and not in the scrotum, a condition known as undescended testis. If the testis fails to descend by the second year of life, the high body temperature of the abdomen will begin to affect it and cause irreversible damage. This is still one of the most easily preventable causes of male infertility, if a mother/relative notices this in her ward/baby, she should seek specialist attention urgently.
- Retrograde ejacuation.
This is a condition in which during orgasm, the semen joins the urine in the bladder. The semen volume is reduced or at times absent though the man has climaxed, this can be caused by age related changes in the bladder neck. Some medical conditions such as hypertension and diabetes or their treatments may also make this worse
- Lifestyle factors
Recreational drugs such as excessive alcohol intake, cigarette, marijuana, cocaine and anabolic steroid use can all affect sperm quality. Excessive weight gain and lack of exercise are also contributory. Some medications used in treatment of hypertension, ulcer and depression can all cause low sperm count in men.
This list is not by any means exhaustive but these are the commonest causes of male factor infertility. It is essential that both partners are tested accordingly and there is prompt referral to a fertility specialist when a problem is detected.