In this interview, Dr Amina Asani founder/CEO Ruminacare – a digital platform with a holistic approach to health issues, shares her expertise on male reproductive health, importance of lifestyle modifications and holistic care, amongst other key issues.
1. What are the common misconceptions about male fertility and how do you address them in your practice?
It is often believed that the woman is at fault when couples are dealing with inability to conceive. However, contrary to popular belief, recent studies have shown that the commonest cause for primary infertility is as a result of male factor infertility. The quality of the sperm is not as it used to be, as a matter of fact it is on a sharp decline. This may be as a result of lifestyle such as drinking alcohol, smoking cigarettes, e-cigarettes, and drug use. Chemicals found in these substances have been shown to have negative impact on the production and quality of sperm. Another misconception is that age does not affect male fertility. This is not true as studies have shown that from age 40, the male sperm count and motility begins to decline also the DNA that makes up older sperm cells begin to break up around this age. One way I have tried to tackle this is via my social media page where I organise health talks/put out information for both women and men to help create awareness on issues relating to not just reproductive health but also sexual health. That way I can pass on free health information to a great number of people in the comfort of there homes.
2. How do you counsel, men who are struggling with infertility particularly those who may be experiencing emotional distress or feelings of inadequacy?
(Pauses)… this is usually a very difficult one. You know, majority of men do not believe that they might actually be the reason for their inability to conceive, so when they get a diagnosis that actually points them out as the reason, it hits them really hard. Studies have shown that women are more easy to share their emotional problems relating to infertility or join a support group. Men on the other hand bottle up most of their frustrations and sometimes express it through anger. This is because men equate their manliness with their ability to impregnate their wives, not only this, they also feel like they are going to miss out on an important life experience such as having their heir carry on their name. At RuminaCare we look at every health problem holistically and that is why we have partnered with professionals from other works of life such as clinical psychologist, yoga specialist and nutritionist. Our care is centered around the patient. Before any patient undergoes any test to evaluate their fertility status they are first counseled adequately to understand what the outcome of the result may look like and the treatment options available. For patients who are already struggling with emotional distress or depression/whom we suspect may not handle the outcome of the result well, we engage them with our clinical psychologist and yoga specialist. The clinical psychologist will help with further counseling while the yoga specialist will help them connect to self and relief every form of tension. Often times counseling and yoga helps patient prepare for what is to come, and it also helps them manage there emotions better.
3. What are the latest technological advancements in male fertility treatments and how do you determine which treatment options are best for each?
Over the years a lot of progress has been made in the field of fertility medicine to ensure that every couple is given the opportunity of fulfilling their dream of starting a family. Majority of the issues relating to male infertility revolves around the sperm production, quantity, quality and morphology of the sperm. All patients will not require the same level of treatment that is why appropriate history taking and seminal fluid analysis(sperm test) is important before writing out the treatment plan.
There are so many technological advancements for male fertility treatments, I will go on to name a few;
– Intrauterine insemination (IUI): issues with motility can be treated via IUI taking into consideration that the woman’s fallopian tubes are patent.
– Intracytoplasmic sperm injection(ICSI): Patients who present with issues with low sperm count and motility will most likely benefit from intracytoplasmic sperm injection(ICSI) this involves direct injection of a single sperm cell into the egg facilitating fertilization.
– Testicular sperm extraction (TESE): Another procedure that can be done to assist men with fertility issue especially problems relating to sperm production is Testicular sperm extraction. This is a surgical procedure where a small tissue sample is taken from the testicles to extract viable sperm for use in Assisted reproductive techniques. However both ICSI and TESE will mean that couples will undergoing invitro fertilization (IVF).
– Cryopreservation of sperm(sperm freezing): which allows men to preserve their sperm for future use particularly for those undergoing treatments such as chemotherapy that can affect fertility.
– Other options include MicroTESE, sperm DNA fragmentation, And of course life style modification, one can never over emphasise its benefit.
4. How do you approach discussions around reproductive health with men who may be hesitant or uncomfortable seeking medical attention?
Many individuals struggling with problems relating to reproductive health find it difficult to seek medical attention not because they don’t want to but often times it’s because they feel no one will understand them or they may have a feeling of guilt about something they may have done in the past that led to their issues. As a matter of fact, they desire psychosocial help but not in an individual or group manner because they feel too shy or feel that someone may share their information with someone else that knows them. So what I like to do is use a self-administered approach through the use of questionnaires. I develop questions relating to what the issues are and allow the patient answer this questions in the comfort of their home before meeting them in person. That way I would have bypassed all the awkward issues virtually and by the time we are meeting, patient is more comfortable to discuss because we will most likely be at the stage of examining and treatment plan. Most couples/ individuals feel more comfortable sharing their medical details virtually compared to face-face interaction because virtual communication creates a barrier between you and the patient allowing them to be able to reveal their true self.
5. What role do you think hormonal imbalances play in male reproductive health, and how do you diagnose and treat hormonal issues?
Hormones are the body’s chemical messengers, they travel round the bloodstream telling the tissues and organ what to do. They play an important role in the male reproductive system. Just like women, men require a balance in key hormones such as follicle stimulating hormone( FSH) and leutinising hormone (LH) in order to be able to reproduce. In men, LH is the hormone in charge of testosterone production.Testosterone helps with the optimization of libido and erection, it plays an important role in fortifying the bones and muscles while FSH stimulates sperm production. An imbalance of any of these hormones can affect various glands such as the hypothalamus, pituitary gland,thyroid, prostate, and testicles. A disruption of any of these can affect sperm production and quality which will then hamper fertility. Asides this, hormonal imbalance also lead to low libido, erectile dysfunction, depression, gynaecomastia (development of breast tissue), and musclar fatigue.
Before making a diagnosis of hormonal imbalance, questions will be asked around the patients medical history this will give an insight about medical conditions, drugs, or treatment that can predispose one to hormonal imbalance. Secondly, a physical exam is also important as it can reveal changes in the reproductive organ. Lastly, a hormone screen which is carried out by blood sample collection, this is the only way to measure the level of hormones in the human body. Other forms of investigation includes: ultrasound scan of the testicles, seminal fluid analysis, and thyroid gland assessment.
Based on results of investigation, combined with the physical examination, symptoms and medical history, a diagnosis can be made and a treatment plan tailored to the patients need can be developed. Treatment of hormonal imbalance include lifestyle modifications, exercise, hormone replacement therapy and supplements.
6. How do you address impact of lifestyle factors such as stress, diet, and exercise on male reproductive organ.
There are a wide range of lifestyle factors that can potentially influence sperm quality. Over the years, studies have show that certain lifestyle factors such as psychological stress, obesity, excessive exercises, smoking, and consumption of alcohol play a major role in male infertility. For example a poor nutrition and sedentary lifestyle results in obesity, obesity in men has been associated with a higher risk of azospermia and oligospermia, it also predisposes the man to a higher risk of sperm DNA damage. Also, excessive intake of alcohol has been linked to testicular shrinkage, changes in sperm parameters, while smoking is linked to reduced semen quality. The negative effects of majority of these lifestyles can be overcome to an extent by behavioral modification and better lifestyle choices. In my practice, I like to take advantage of the positive benefits of the social media, it enables me to not only create awareness but I also use that opportunity to educate people on how unhealthy habits impact not just the reproductive system but also their overall health, while simultaneously educating the audience on how to lead a healthy lifestyle that will not only aid their ability to conceive but also prevent them from having health complications that can negatively impact their total wellbeing. Also, whenever I have a face to face consultation with couples, I counsel adequately on the benefits of a healthy lifestyle when trying to conceive.
7. What are the most common reproductive health issues affecting men in different age groups (e.g young adults, middle aged men and older men)?
Most young people are more likely to contact an STD as a result of the carefree lifestyle they engage in. In the quest to take charge of their lives, they are often secretive and as result, deprive themselves of valuable informations. The lack of knowledge of preventive measures and how to access care leads to cases of untreated chlamydia and gonorrhea which by the way are the most reported disease amongst young adults. These infections, if left untreated cause significant health problems including infertility, increased risk of other diseases like herpes, HIV infection and HPV (Human Papilloma Virus) which is linked to penile and oropharyngeal cancers in men. On the other hand, middle-aged men and older men are faced with reproductive health issues related to Age, lifestyle, co-morbid conditions (like hypertension, diabetes, prostate issues), and drugs used to treat these conditions. The commonest reproductive health issue which is linked to all these factors in both age group is Erectile dysfunction. Studies have shown that men within this age group who have co-morbid conditions, smoke, consume alcohol, or those who are obese/lead a sedentary lifestyle, report a high rate of erectile dysfunction (ED).
8. How do you handle cases where male reproductive health issues may be related to underlying medical conditions such as diabetes or hypogonadism?
Well, it depends on the underlying condition that led to the reproductive health issues. For example, men with diabetes who develop erectile dysfunction or low testosterone can have an improvement in there condition by simply adhering to proper intake of their medications and also incorporate healthy lifestyle changes such as exercises and healthy diets. In case of hypogonadism it may be congenital ( born with) or it may develop later in life as a result of aging or injury. Men who have hypogonadism have low testosterone production by the testicles. This can be as a result of problems with the glands such as hypothalamus and pituitary gland that secrete/stimulate the release of the hormones responsible for testosterone production. Men who have hypogonadism show symptoms like reduced sex drive, erectile dysfunction, shrinking testicles, low or no sperm count and so on. Men who have hypogonadism benefit from testosterone replacement therapy. Overall, patients who present with underlying conditions usually require a multi-specialist approach. Often times, they are scheduled to see an endocrinologist who specializes in the management of these conditions.
9. What is your approach to discussing fertility preservation options with men who may be facing medical treatments that could impact their reproductive health (e.g chemotherapy, radiation)?
At RuminaCare, we partner with hospitals that have the expertise and experience in Cryopreservation. Every patient under going cancer treatment is appropriately counseled about Cryopreservation of sperm before cancer treatments begin and are referred to facility’s that will carry out this procedure. All patients are advised about the potentially high risk of genetic damage in sperm collected after treatments have been initiated. One cycle of cancer treatment can affect the quality of the sample and sperm DNA integrity. Patients with low sperm count who do not have the luxury of time for multiple sample collections are equally advised to bank what ever is produced. Thankfully, technological advancements such as intracytoplasmic sperm injection gives room for fertilisation of egg with limited quantity of sperm.
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