MALE INFERTILITY
About 2 weekends ago , I was 'thoroughly' bored in Chaaria on a Saturday evening . I decided to go to Meru Town for company and joined some friends watching football( I know nothing about the game). As they sipped their beer and I continued with my delmonte, they kept making fun of my 'blondness' and total ignorance on matters football; they made it their business to teach me about the game . In the course of conversation, a topic on male infertility somehow arose. They are non-medics so they were very inquisitive about it all. The guys kept on challenging me with questions and giving suggestions on probable treatment . I must say they were very accurate on their suggestions to my amusement . The topic got so intense such that I noted other people in the restaurant starting to pull their chairs towards us and listening keenly to the interesting talk. One of my friends is extremely loud hence the added attention. I was also careful to keep my professionalism and talk only about the theory of the condition without giving any statistics.
I had also written about this topic a while back in my blog about the intense dilemma I go through telling patients about this condition. To most African men it becomes a source of ridicule in society and others even commit suicide. Confidentiality is key in managing this condition , sometimes to the extent of keeping it secret away from the female spouse and letting her continue being branded as the 'problem' by society as we try to find a solution to the husband's condition. This is an extremely chauvinistic way of handling it but hey, this is Africa. A woman can take the ridicule and remain hopeful. That is the general mindset here. Medically it is also easier to treat female infertility compared to male infertility.
Male subfertility or infertility is the inability of a man to make a woman conceive through the natural process. It can be due to a genetic, physiological, pathological or mechanical problem in the production or transport of spermatozoa. About 1 in 20 men are subfertile.
The process of sperm formation starts at puberty and continues throughout life. It takes a total of 74 days for sperm formation to be complete and a further ten days for it to be transported to the epididymis for storage for use during ejaculation. The head of the epididymis stores 70% of mature sperm and during ejaculation it exists through the vas-deferens to the urethra.
The real cause of the infertility could be due to total inability to produce mature viable sperms(AZOOSPERMIA), production of abnormal forms of sperm without the ability to move or penetrate an ovum, production of normal sperm but in low quantity (OLIGOSPERMIA), production of normal sperm in quality and quantity but blockage anywhere in the transport system from production to ejaculation , impotence e.t.c. Other factors like getting infected with Mumps in a male child can also cause male sub-fertility later in life due to destruction of the testicular cells.
This condition is first investigated by doing a SPERM-ANALYSIS. This is done after 3-7 days of total abstinence and studying the quantity and quality of the sperms. A normal quantity is more than 20million sperms per one milliliter , with atleast 40 million per ejaculate, atleast 60% normal motility and atleast 30%normal morphology and a pH of above 7.2. Severe acidity can destroy normal sperms.
The next step is doing hormone analysis to rule out production impairment. This can be managed using hormonal treatment.
If hormone analysis is normal, the next step would be doing more intense studies to rule out any mechanical obstruction in sperm transport or even absence of the transport mechanism e.g total lack of vas deferens. Unfortunately this can only be done in very specialized fertility centers and we only have one of such in the country somewhere in Nairobi.
My loud friend kept on giving suggestions on treatment modalities based of above causes and he was absolutely correct and gave all treatment modalities. If a man has normal spermatozoa but in abnormally small quantities, IN-VITRO FERTILIZATION can be done and this involves harvesting the sperm , harvesting ovum , 'fusing' them and doing insemination into the uterus of a fertilized product for implantation.
If the problem is normal production but mechanical blockage in transport, SURGICAL SPERM RETRIEVAL(SSR) can be done. This is a surgical procedure done in theatre in which sperms are extracted directly from the testicles or epidydimis using a fine needle and then used for IVF.
The above treatment modalities are only done in very specialised centres and outcomes vary from individual to individual.
In the case hormonal treatment fails for total lack of sperm production , a DONOR SPERM can be used and injected into the uterus from a chosen donor or from a sperm-bank.
Other couples agree on having the woman conceive naturally and secretly using a selected 'Donor'. This is a cheaper way out but the legal,ethical, religious, cultural,
and emotional implications associated with this method discourages it's use especially in this era of diseases. It was however wildly practised in ancient African Communities mostly using blood relative 'donors'.
They asked me if Miraa (Khat) can cause male subfertility but I don't know about this. The problem could be due to impotence. Research is needed.
We looked at our watches and we were shocked to realise it was well past midnight. The conversation had been so intense. It's a topic that is very extensive but also very sensitive . I hope the post is educative. Any suggestions or questions are welcome.
