Prof. Oladapo Ashiru

Infertility is the inability to achieve pregnancy after one year of unprotected intercourse. But, according to the American Society for Reproductive Medicine and recently at a WHO expert meeting, we revised the definition to encourage earlier evaluation in the highest risk group. Now, any man or woman aged 35 years should seek fertility evaluation or treatment after six months of trying.

The conditions that affect male fertility are still generally under-diagnosed and undertreated. In our society, the burden is placed more on the female partner when it comes to conception. When a couple can’t conceive after a year, the community automatically blames the woman. This assumption is false. Male infertility accounts for about 40 per cent of childless marriages. About seven per cent of men are infertile, but most men with fertility problems are reluctant to come for further testing and treatment.

The male partner can be evaluated for infertility or sub-fertility by using a variety of clinical interventions and also through laboratory evaluation of semen (WHO-Semen manual, 5th Edition).

A man’s fertility generally relies on the quality of his sperm. If the sperm concentration in a man’s ejaculates is low or if the sperm is of poor quality, it will be difficult and sometimes impossible for him to achieve pregnancy.

The words ‘low sperm count’ and ‘no sperm’ are terrifying terms to hear for many men and couples alike, especially when there is a history of infertility.

Oligozoospermia or ‘low sperm count’ refers to semen with a low concentration of sperm cells and it is commonly associated with male infertility.

Based on recent World Health Organisation criteria, a concentration of less than 20 million sperm/ml of semen is oligozoospermia. There are also different classes of oligozoospermia (ranging from mild to severe).

While it requires only one sperm to fertilise the ovum, the odds of conception are such that it takes millions of sperm to achieve the goal of fertilisation. A “normal” sperm count is about 20 million or more sperm per millilitre of semen. Over four per cent of the sperm in each sample should exhibit normal morphology and indicate normal motility – the forward swimming movement.

Azoospermia (no sperm) is the complete absence of sperm in an ejaculation. It is a well-known cause of male factor infertility.

Cryptozoospermia means the sperm is not observed in a fresh semen sample, but it is later found after extensive centrifugation and microscopic search.

Male infertility is usually caused by problems that affect either sperm production in the testes or sperm transport.

The production of sperm is a complicated process and requires normal functioning of the testicles (testes), as well as the hypothalamus and pituitary glands – organs in your brain that produce hormones that trigger sperm production. Once the sperm is produced in the testes, delicate tubes transport them until they mix with semen and are ejaculated out of the penis via the urethra.

Problems with any of these systems can affect sperm production.

A detailed history and physical examination are done by a clinician to check for possible causes, such as varicocele, testicular atrophy, undescended testis and other abnormalities. A seminal fluid analysis is done to assess the sperm parameters accurately, usually, patients are advised to abstain from intercourse for a period between two and seven days before taking this test for optimal results. Further testing, including hormone profile and scrotal ultrasound, may be done primarily to check for other underlying causes.

The other causes related to the male lifestyles include alcohol consumption, which can lower testosterone levels and cause decreased sperm production.

Weight/ Obesity can also impair fertility in several ways, including directly impacting sperm and by causing hormone changes.

An occupation like welding or those associated with prolonged sitting, such as truck driving, may be linked with a risk of infertility. However, the data to support these associations are inconsistent.

Tobacco smoking in men can result in lower sperm count than in those who don’t smoke. Drug use, especially in the form anabolic steroids taken to stimulate muscle strength and growth, can cause the testes to shrink and cause a decrease in sperm production. Use of cocaine or marijuana might reduce the number and quality of your sperm as well.

Medical conditions are also associated with infertility, such as mumps, tuberculosis, sexually transmitted diseases, like gonorrhoea and syphilis, among others, are responsible for male infertility.

…to be continued.

By Prof Oladapo Ashiru

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