Do you know that male Infertility problem is on the rise in Nigeria right now? City People recently discovered that when it conducted a research that suggested that more and more men are finding it difficult to impregnate their wives. So, what are the causes of this problem and what is the way out? A few weeks back, City People Publisher SEYE KEHINDE spoke to a Fertility Specialist and Gynaecologist, Prof. Osato Belo-Osagie who threw more light on the situation.
Prof. Osato Belo-Osagie is a Gyneacologist of many years standing. He is also an award winning Professor of Medicine who now runs a fertility centre at Onikan area of Lagos. Recently, Prof. Osato Belo-Osagie was asked why the issue of Infertility has been on the increase for quite sometime now in Nigeria and why women suffer from a lot of fertility-related problems.
“A lot explains this”, he said. “But I won’t say these problems are recent. It has always existed. If you go back 25 years to 40 years you will see that all these things were also happening then, but people were not as aware it like they do now. The women are more educated now so they complain earlier about things. They now seek solution rather than have their mothers keep quiet and be praying. They now go to the doctors and complain that I have Fibroids”.
The older ones didn’t know these technical terms and sometimes thought that they were caused by spirits. 2ndly because they are more educated, they make their feelings better known to their husbands and their relations. 3rdly, we have more accurate methods of diagnoses. For instance, ultra sound is very widespread now and all other techniques are available. So, we quickly find out faults as we test the person, unlike before when we had to do sperm counts, and an x-ray of the tube. That is it. But there are so many other things that can be wrong. In the past, there are so many things that were not tested. That is basically it.”
On why Infertility problem is on the rise? he said one reason is because the level of knowledge has increased. Two, there are more things that can go wrong like Abortion, sexually transmitted diseases Gonorrhea and so on. These are things that cause havoc to fertility. 3rdly, other things that we do like smoking cigarette and Alcohol plus not marrying in time. All these add up to the causes of Infertility”.
For women experiencing Infertility problems, what are the ways out? Is IVF the only solution? “IVF was basically designed for treating people with blocked tubes. That was how it started. People whose tubes are damaged, due to abortion, people who have lost their tubes due to Etopic pregnancy or due to Gonorhea and so on. It was then found out that it can be used to treat people with low sperm count. So it is used for a lot of things now.”
But how do doctors deal with Male Infertility because for a long time people use to see Infertility as a female problem? “I think now if you did an analysis, lets say 20 years ago, you will find out that 60% of the problems are female and may be 30% are male, then 10% are no cause found. It is now almost 40% – 40% between women and men and then 20% are no specific cause. So, we have to take very seriously the contributions of males to infertility. That is why we also use IVF to treat Male Infertility. When a man has low sperm count it can be treated by IVF because you require fewer sperms for IVF than for natural conception.
So, what is Infertility all about? It refers to an inability to conceive after having regular unprotected sex over a long period of time. Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term. In many countries Infertility refers to a couple that has failed to conceive after 12 months of regular sexual intercourse without the use of contraception.
Studies indicate that slightly over half of all cases of infertility are a result of female conditions, while the rest are caused by either sperm disorders or unidentified factors.
RISK FACTORS
In medicine, a risk factor is something that raises the risk of developing a condition, disease or symptom. For example, obese people are more likely to develop Diabetes type 2 compared to people of normal weight; therefore, obesity is a risk factor for Diabetes type 2.
Age – a woman’s fertility starts to drop after she is about 32 years old, and continues doing so. A 50-year-old man is usually less fertile than a man in his 20s (male fertility progressively drops after the age of 40).
Smoking – smoking significantly increases the risk of infertility in both men and women. Smoking may also undermine the effects of fertility treatment. Even when a woman gets pregnant, if she smokes she has a greater risk of miscarriage.
Alcohol consumption – a woman’s pregnancy can be seriously affected by any amount of alcohol consumption. Alcohol abuse may lower male fertility. Moderate alcohol consumption has not been shown to lower fertility in most men, but is thought to lower fertility in men who already have a low sperm count.
Being obese or overweight – in industrialized countries overweight/obesity and a sedentary lifestyle are often found to be the principal causes of female infertility. An overweight man has a higher risk of having abnormal sperm.
Eating disorders – women who become seriously underweight as a result of an eating disorder may have fertility problems.
Being vegan – if you are a strict vegan you must make sure your intake of iron, folic acid, zinc and vitamin B-12 are adequate, otherwise your fertility may become affected.
Over-exercising – a woman who exercises for more than seven hours each week may have ovulation problems.
Not exercising – leading a sedentary lifestyle is sometimes linked to lower fertility in both men and women.
Sexually Transmitted Infections (STIs) – chlamydia can damage the fallopian tubes, as well as making the man’s scrotum become inflamed. Some other STIs may also cause infertility.
Exposure to some chemicals – some pesticides, herbicides, metals (lead) and solvents have been linked to fertility problems in both men and women.
Mental stress – studies indicate that female ovulation and sperm production may be affected by mental stress. If at least one partner is stressed it is possible that the frequency of sexual intercourse is less, resulting in a lower chance of conception.
CAUSES OF INFERTILITY IN MEN
The following are common causes of infertility in men:
(a) Semen – Semen is the milky fluid that a man’s penis releases during orgasm. Semen consists of fluid and sperm. The fluid comes from the prostate gland, seminal vesicle and other sex glands.
The sperm is produced in the testicles. During orgasm a man ejaculates (releases semen through the penis). The seminal fluid helps transport the sperm during ejaculation. The seminal fluid has sugar in it – sugar is an energy source for sperm.
(b) Abnormal Semen is responsible for about 75% of all cases of male infertility. Unfortunately, in many cases doctors never find out why. The following semen problems are possible:
(c) Low Sperm Count (low concentration) – the man ejaculates a lower number of sperm, compared to other men. Sperm concentration should be 20 million sperm per milliliter of semen. If the count is under 10 million there is a low sperm concentration (subfertility).
(d) No Sperm – when the man ejaculates there is no sperm in the semen.
(e) Low Sperm Mobility (motility) – the sperm cannot “swim” as well as it should.
(f) Abnormal Sperm – perhaps the sperm has an unusual shape, making it more difficult to move and fertilize an egg.
Sperm must be the right shape and able to travel rapidly and accurately towards the egg. If the sperm’s morphology (structure) and motility (movement) are wrong it is less likely to be able to reach the egg and fertilize it. Causes of abnormal semen: Testicular infection, Testicular cancer, Testicular surgery.
(g) Overheating The Testicles – frequent saunas, hot tubs, very hot baths, or working in extremely hot environments can raise the temperature of the testicles. Tight clothing may have the same effect on some people.
(h) Ejaculation Disorders – for some men it may be difficult to ejaculate properly. Men with retrograde ejaculation ejaculate semen into the bladder. If the ejaculatory ducts are blocked or obstructed the man may have a problem ejaculating appropriately.
(i) Varicocele – this is a varicose vein in the scrotum that may cause the sperm to overheat.
(j) Undescended Testicle – one (or both) testicle fails to descend from the abdomen into the scrotum during fetal development. Sperm production is affected because the testicle is not in the scrotum and is at a higher temperature. Healthy sperm need to exist in a slightly lower-than-body temperature. That is why they are in the scrotum, and not inside the body.
(k) Hypogonadism – testosterone deficiency can result in a disorder of the testicles.
(l) Genetic Abnormality – a man should have an X and Y chromosome. If he has two X chromosomes and one Y chromosome (Klinefelter’s syndrome) there will be an abnormal development of the testicles, low testosterone, and a low sperm count (sometimes no sperm at all).
(m) Mumps – this viral infection usually affects young children. However, if it occurs after puberty inflammation of the testicles may affect sperm production.
(n) Hypospadias – the urethral opening is at the underside of the penis, instead of its tip. This abnormality is usually surgically corrected when the male is a baby. If it is not the sperm may find it harder to get to the female’s cervix. Hypospadias occur in about 1 in every 500 newborn boys.
(o) Cystic fibrosis – Cystic fibrosis is a chronic disease that affects organs such as the liver, lungs, pancreas, and intestines. It disrupts the body’s salt balance, leaving too little salt and water on the outside of cells and causing the thin layer of mucus that usually keeps the lungs free of germs to become thick and sticky. This mucus is difficult to cough out, and it clogs the lungs and airways, leading to infections and damaged lungs. Males with cystic fibrosis commonly have a missing or obstructed vas deferens (tube connecting the testes to the urethra; it carries sperm from the epididymis to the ejaculatory duct and the urethra).
(p) Radiotherapy – radiation therapy can impair sperm production. The severity usually depends on how near to the testicles the radiation was aimed.
(q) Some diseases – the following diseases and conditions are sometimes linked to lower fertility in males: Anemia, Cushing’s syndrome, Diabetes, Thyroid disease.
CAUSES OF INFERTILITY IN WOMEN
There are many possible causes of Infertility. Unfortunately, in about one-third of cases no cause is ever identified.
(A) OVULATION DISORDERS
Problems with ovulation are the most common cause of infertility in women, experts say. Ovulation is the monthly release of an egg. In some cases the woman never releases eggs, while in others the woman does not release eggs during come cycles.
Ovulation Disorders can be due to: Premature ovarian failure – the woman’s ovaries stop working before she is 40.
PCOS (polycystic ovary syndrome) – the woman’s ovaries function abnormally. She also has abnormally high levels of androgen. About 5% to 10% of women of reproductive age are affected to some degree. Also called Stein-Leventhal syndrome.
Hyperprolactinemia – if prolactin levels are high and the woman is not pregnant or breastfeeding, it may affect ovulation and fertility.
Poor egg quality – eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. The older a woman is the higher the risk. Overactive thyroid gland, Underactive thyroid gland, Some chronic conditions, such as AIDS or Cancer.
(B) SCIENTISTS DISCOVER GENE THAT MAY EXPLAIN INFERTILITY
Scientists from the University of Edinburgh reported in the Journal of Cell Science that they identified a gene that controls a vital process in the formation of healthy fertile eggs.
They say their breakthrough will help researchers better understand how cells divide during reproduction, which in turn will help explain low fertility and sterility.
(C) PROBLEMS IN THE UTERUS OR FALLOPIAN TUBES
The egg travels from the ovary to the uterus (womb) where the fertilized egg grows. If there is something wrong in the uterus or the fallopian tubes the woman may not be able to conceive naturally. This may be due to: Surgery – pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix. The cervix is the neck of the uterus.
Submucosal fibroids – benign or non-cancerous tumors found in the muscular wall of the uterus, occurring in 30% to 40% of women of childbearing age. They may interfere with implantation. They can also block the fallopian tube, preventing sperm from fertilizing the egg. Large submucosal uterine fibroids may make the uterus’ cavity bigger, increasing the distance the sperm has to travel.
Endometriosis – cells that are normally found within the lining of the uterus start growing elsewhere in the body.
Previous sterilization treatment – if a woman chose to have her fallopian tubes blocked. It is possible to reverse this process, but the chances of becoming fertile again are not high.
(D) SOME DRUGS CAN AFFECT THE FERTILITY OF A WOMAN
These include: NSAIDs (non-steroidal anti-inflammatory drugs) – women who take aspirin or ibuprofen long-term may find it harder to conceive.
Chemotherapy – some medications used in chemotherapy can result in ovarian failure. In some cases, this side effect of chemotherapy may be permanent.
Radiotherapy
If radiation therapy was aimed near the womans reproductive organs there is a higher risk of fertility problems.
Illegal drugs
Some women who take marijuana or cocaine may have fertility problems.
ASSISTED CONCEPTION
The following methods are currently available for assisted conception.
IUI (INTRAUTERINE INSEMINATION)
A fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected. This procedure must be done when ovulation occurs. The woman may be given a low dose of ovary stimulating hormones.
IUI is more commonly done when the man has a low sperm count, decreased sperm motility, or when infertility does not have an identifiable cause. The procedure is also helpful for males suffering from severe erectile dysfunction.
IVF (IN VITRO FERTILIZATION)
Sperm are placed with unfertilized eggs in a Petri dish; the aim is fertilization of the eggs. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved).
ICSI (INTRACYTOPLASMIC SPERM INJECTION)
A single sperm is injected into an egg to achieve fertilization during an IVF procedure. The likelihood of fertilization improves significantly for men with low sperm concentrations.
DONATION OF SPERM OR EGG
If there is either no sperm or egg in one of the partners it is possible to receive sperm or eggs from a donor. Fertility treatment with donor eggs is usually done using IVF. In the UK and a growing number of countries the egg donor can no longer remain anonymous – the offspring can legally trace his/her biological parent when reaching the age of 18.
ASSISTED HATCHING
This improves the chances of the embryo’s implantation; attaching to the wall of the uterus. The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. The opening improves the ability of the embryo to leave its shell and implant into the uterine lining. Patients who benefit from assistant hatching include women with previous IVF failure, poor embryo growth rate, and older women. In some women, particularly older women, the membrane is hardened, making it difficult for the embryo to hatch and implant.
ELECTRIC OR VIBRATORY STIMULATION TO ACHIEVE EJACULATION
Ejaculation is acheived with electric or vibratory stimulation. This procedure is useful for men who cannot ejaculate normally, such as those with a spinal cord injury.
SURGICAL SPERM ASPIRATION
The sperm is removed from part of the male reproductive tract, such as the vas deference, testicle or epididymis.
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