Editorial

Causes of male infertility  

Male Infertility

In an interview with The Voice Florence Ugbem, a consultant urologist with the Benue State University Teaching Hospital, Dr Edwin Ogwuche, speaks on the treatment of male infertility among other areas. Excerpts:

What is male infertility?
Male infertility is a disease of the reproductive system, it is said to occur when a couple that has been having unprotected regular intercourse don’t achieve pregnancy after twelve months of cohabiting together and that is also to assume that they do not have any other problems like breastfeeding because if a woman is breastfeeding even if they are cohabiting for one year and she is not pregnant that is not infertility.
World Health Organization WHO recommends one year not six months we usually reassure them and this is based on the principle that up to 40% of couples will achieve pregnancy within the first one year
How common is male infertility?
It is a common problem, it is said to affect 15% of couples, fifteen out of every hundred couple, will actually have one form of infertility problem or the other. It is said that of a 100%, 40% of male population are affected while 40% affect females , then you have couples that both the male and female will also have problems that constitutes about 20%.
What are the types of male infertility?
There are two main types of male infertility, primary and secondary infertility. The primary infertility is when the couple have never achieved pregnancy at all, that is since they got married they have never had a baby, it is said to be secondary when they have had a child ,there are so many couples like that, that you see they have had a child or two then can’t have another .
Causes of male infertility?
We can divide the causes broadly into two types, congenital or acquired. What we mean by congenital are things that people are born with, there are problems that a man can be born with that will make him infertile in later life the same can also happen to the female but we are focusing on the males. When we talk about acquired causes there are so many things in our environment that can affect the man’s sexuality and of course his potency.
To enhance our understanding we can look at it at different levels, we have at the level of the brain, at the level of the testis and beyond the testis.
To enhance our understanding, we can look at the causes as either pre-testicular that is before the testis, at the level of the testis or beyond the testis
At the pre-testicular level there are congenital problems ,one is born with, that affect the pituitary gland , hypogonadism, luteinizing hormone deficiency and these are congenital problems and they are forms of hormonal imbalance it could be congenital it also can be acquired when someone is taking certain drugs that causes an imbalance ,which can cause infertility. If you move down to the testicular level there are also congenital issues, which include those who have undescended testicles which is called cryptorchidism for instance if the testis do not come to the scrotum at the time it should, which should happen at birth and it is within the abdomen it affects the quality of sperms that the testis will produce you can have chromosomal abnormalities you know the normal male has XY chromosomes but you can have people who have either a duplication of some of those chromosomes or you have delision in certain chromosomes and once they have them it becomes a problem also those who have varicocele which is an abnormal dilation of some blood vessels around the testis and that affects the production of sperms and the quality of sperms also .
Then the post testicular, you know that men also have tubes which we call the vas deferens the commonest cause is infection so a man has had repeated infection that affects his vas deferens and his tubes will get blocked just like you hear of blocked tubes in females even though the testis is producing sperm the sperm will not be transported to get back to the later base and when this happens he cannot impregnate his wife .
What are the symptoms of male infertility?
The first symptom that the man or couple will manifest is he will notice that they will not be able to achieve pregnancy despite having regular cliotis. A man with a congenital abnormaly that has to do with the penis who cannot have sex and cannot properly ejaculate and already knows from the beginning those ones may not even get to the point of getting married but if a couple is already married before we can define them as infertile they must be having regular intercourse and then after one year once they are not able to achieve pregnancy we know they are talking of infertility and then we do evaluation. Is it possible that it is at the testicular level, at the post testicular level or the pre-testicular level these are the different ways we can now assess them
The first thing you want to look at is are they living together and having regular intercourse ,do they understand the menstrual circle ,the issue of cohabiting appears simple but very important you have these days people are pursuing different careers ,the man is in Abuja while the wife is in Lagos you can’t do these things by correspondence so they must cohabit and even if they are cohabiting he has to have intercourse when the woman is in her fertile period for her to get pregnant it is important to emphasize that people live together before you can judge them as infertile ,you want to assess how often they have intercourse ,you have to look at whether the man has good erection if he has problems with the penis and all of that and then you are checking them for other things in the environment ,such as the use of alcohol, cigarette smoking ,the use of herbicides those are all different environmental factors that can affect male fertility, also the kind of under wear they wear nylon pants are notorious and increase the temperature around the testis and that could affect the production of sperms from the testicles ,then occupational hazards ,it is said that long distance drivers are at risks those ones that drive heavy duty vehicles and their engines is very close to where the driver sits ,some of them that drive buses are sitting right on top of the engine, the temperature can affect the production of sperms these are things we need to find out in the history that will help you in managing the couple ,for some of them just modifying their lifestyle , alcohol intake reducing obesity basic exercises will be enough to correct it
What is the level of alcohol intake that can be safe and what kind of under wears do you recommend for men?
The issue of alcohol intake is a major challenge just like people have different tolerance level for instance someone can take a bottle and he is knocked out, while another can take six bottles and still drive himself home, so it is difficult to say this is the quantity that would affect fertility. But if we identify that the man already has issues with alcohol and his infertile then it is simple, ask him to stop alcohol and see how his sperm count will improve after wards but as per quantity it is difficult to determine
Nylon pants are known to increase the temperature around the testis what is recommended is that man should wear loose under wears, we have cotton based boxers cotton pants that will not adversely affect sperm production. Also personal hygiene is very important because it has to do with infection and we have said that infection is a cause of secondary infertility it is one of the acquired causes so if someone has problems with personal hygiene around the genitia then that can be an issue in fact it is worse with females because their tract is more open than that of the males
The use of aphrodisiacs does it affect fertility in male?
No in fact sex enhancing drugs are expected to improve the quality of erection and also the libido, men who need that to improve libido, erection and quantity of sperms if they have infertility it is going to facilitate getting their spouse pregnant but on their own that do not cause infertility instead we use them to treat certain forms of infertility
What is the ideal sperm count?
For sperm count the recommendation by the WHO is that the volume should be two millilitres ML, the male is supposed to produce between twenty to sixty million , anyone who has less than twenty million is unlikely to pregnant a woman without assistance then if we are looking at the motility then it is recommended that at least 50% of the sperms should be actively mortal because you are depositing at a remote distance where they are supposed to meet the eggs for reasons best known to the Almighty God you need at least that number for you to be able to achieve pregnancy so anything less than twenty million is not good enough.
To be continued.

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