Sperm counts have plummeted over the last four decades. In this report by Sade Oguntola, experts say it’s not just the number of sperm as their shape, oxidative stress and possible DNA fragmentation too are important in ensuring conception.
What is not up for debate is that many men do struggle with fertility problems — and they are often uncomfortable talking about it and reluctant to get help. It is almost like male fertility is not considered as a major component. But it does comprise a sizeable portion of the reasons couples present with infertility.
But there is a lot more that can go wrong with a couple’s ability to have children. Sperm count among Nigerian males is declining and this is partly responsible for the increased infertility among couples in the country
“In a study we carried out in our clinic in 2018, we found that as many as 12 per cent of the men had no sperm cells in their ejaculate. Also, in some men despite a normal sperm parameter, natural conception fails to happen” said Dr Abayomi Ajayi, the Managing Director, Nordica Fertility Centre, Lagos.
Dr Ajayi speaking at a virtual meeting on “The struggle with Male Factor Infertility” organised by Nordica Fertility Centre and the Association for Fertility and Reproductive Health, said “it is usually a struggle for both the affected couple as well as the health practitioner who is confronted with the task of explaining to the man that he is not producing any sperm cells despite his virility.”
Mr Ayodeji Adeoye, an embryologist at the Nordica Fertility Centre, stated that male fertility comprise approximately 30 per cent of the reasons couples present with infertility: and an additional 30-40 per cent in combination with other factors.
He stated that male infertility has become a global issue that is increasing at an alarming rate as men increasingly experience a decline in sperm concentration, motility (ability to swim) and morphology (shape of the sperm).
According to World Health Organisation, male factor infertility is the presence of greater or equal to one abnormality in the semen analysis or the presence of inadequate sexual or ejaculatory function. These semen parameters are sperm’s concentration, motility and morphology.
Mr Adeoye, however, said that low sperm count or poor sperm quality or both is a major reason many men have male factor infertility.
Conversely, he stated that aside from sperm’s concentration, motility and morphology, it is possible for the problem to be due to genetically fragile sperm.
A man’s sperm carries half the genetic material necessary to make a complete human being. A woman’s egg holds the other half. Increasingly, experts are reporting incidences of men with genetically fragile sperms. Such sperm have fragmented DNA chains, which make them to be of low quality and less capable of fertilisation.
He stated that studies suggested that the DNA fragmentation in the sperm were caused by presence of free radicals and sperm fragmentation ration was higher in men that are obese, binge alcohol and in older persons.
“Even if the sperm count is fine, motility is good and the morphology is of high quality, but the DNA fragmentation of the sperm is high, it will affect the development of embryo greatly and the possibility of achieving pregnancy,” he declared.
Howbeit, Mr Adeoye said that male infertility can be caused by various factors such as diabetes, illness, injury to reproductive anatomy, obstruction or sexual dysfunction, infections, alcohol intake, cigarette smoking, obesity and drug use. These factors can temporarily or permanently affect sperm and prevent conception.
“With diabetes, one in four have a low testosterone level and this low testosterone level affect sperm production, including the sperm concentration. Apart from that, they have a low sex drive. There are sexually transmitted infections, such as gonorrhea, which can damage the epididymis or testicles. About 2-8 per cent of male infertility is due to genetic factors, including chromosomal abnormalities.
“There are some occupations that are hazardous to men such as the fire fighters because of heavy exposure to fire retardants as well as petroleum workers. Extended exposure to certain chemicals, pesticides, organic solvents and painting materials also contribute to low sperm count.
“In a research done in our fertility clinic to check the effect of the mobile cell phone usage on semen analysis, we discovered that the sperm concentration, motility and morphology was higher in people in the group without using mobile cell phone compared to those that used mobile cell phone less than 2 hours per day and 4 hours per day.”
Mr Adeoye stated that some interventions can help reduce the amount of sperms with DNA fragmentation such as frequent ejaculation and antioxidant therapy. Vitamins C and E present in high concentration in semen prohibit DNA damage.
Dr David Mortimer, a fertility expert said a major intervention to help men with male infertility was semen analysis to ensure that only the good sperm will be collected and used for treatment. It allows over 30 per cent reduction in the number of sperms with damaged DNA.
According to him, “traditional descriptive human semen analysis has limited diagnostic value and very little prognostic value especially in ART cases. In ART, we must move from “descriptive” to “functional” sperm characterization, identifying the risk of fertilization failure rather than seeking correlations with success. The quality of test results is vital.”
Professor James Gosalvez, a genetic biologist at the University of Madrid stated that sperm DNA fragmentation is an important parameter to be included in standard semen analysis as sperm DNA fragmentation has been shown to have a multifactorial origin and it can be used as the ultimate indicator of abnormal sperm production.
According to Professor Gosalvez, “for fertilization, the proportion of spermatozoa with DNA fragmentation in the ejaculate can be controlled after an adequate sperm selection procedure.”
Professor Ralf Henkel, an adjunct senior scientist, American Centre for Reproductive Medicine, Department of Urology, Cleveland Clinic, Cleveland stated that sperm DNA fragmentation is a global issue to consider considering the global incidence of male infertility.
According to Professor Henkel, oxidative stress is a significant contributory factor to male infertility being a cause of DNA damage.
He declared that aside from age being a contributor to oxidative stress, environmental factors like pollution, lifestyle issues like smoking, alcohol use, sedentary position, genital tract infections and drugs, all contribute to oxidative stress in the body that leads invariably to DNA damage.
Professor Henkel declared, “oxidative stress affects sperm function in 80 per cent of these men with infertility. Oxidative stress negatively affects all sperm functions, including motility and sperm DNA fragmentation. Also, sperm DNA fragmentation can lead to replication errors, de novo mutation, genetic disorders of the offspring which is important in having healthy offspring.”
But, in reducing risks of sperm DNA fragmentation, he said studies have shown that intake of antioxidants like vitamins A, C, E, selenium, zinc, exercise, and regular ejaculation may be helpful.
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