The excessive fee of male infertility has grow to be a giant fear to many well being practitioners.
Research findings present that extra males are affected by infertility than ever, a improvement described by a fertility scientist, Dr Shanna Swan, as a “global existential crisis.”
Swan warned, “The current state of reproductive affairs couldn’t continue much longer without threatening human survival.”
According to the US Population Reference Bureau’s 2021 Data Sheet, fertility is down in many countries, together with low, center and high-income nations.
The World Health Organization, WHO, has additionally recognised the decline in counts and high quality of spermatozoa, which gave rise to its revision of the standards for regular versus irregular sperm counts for use by andrology laboratories worldwide.
Normal sperm rely ranges from 15 million sperm per millilitre to 200 million per millilitre. The WHO deems a fee beneath 15 million as “low.
Male fertility has been blamed for a whopping 60 per cent of infertility cases. Yet, conditions affecting male fertility are still generally underdiagnosed and undertreated.
Scientists said that infertility doesn’t just alter a man’s ability to make children; it also increases his mortality risk.
According to a Stanford University study, infertile men die younger than their infertile peers. Men with sperm concentration lower than 15 million per millilitre had a 50 per cent greater chance of being hospitalised for any medical reason at all, and poor fertility has been linked with higher rates of diabetes, heart disease and cancers.
Several causes and risk factors have been speculated and, in some instances, proven for male infertility and published in the medical literature.
Some of these include smoking, alcohol intake, drugs, obesity, past or present testicular infections, exposure to environmental toxins, exposure of the testicles to excessive heat, hormonal disorders, testicular trauma and ejaculatory/erectile disorders, among others.
Similarly, a study by a group of scientists from Nigerian universities who reviewed research on male infertility classified the causes and risk factors into physiological or biological, behavioural or lifestyle, environmental, and socio-demographic.
Despite the evidence of declining sperm counts worldwide and the increasing prevalence of male infertility, there has been limited public enlightenment about the potential causes and risk factors for male infertility.
Speaking to Media Talk Africa concerning the development, Dr Ajayi Abayomi, the Medical Director of Nordica Fertility Clinic, Abuja, provided more insight on male infertility.
Abayomi, a fertility specialist, discussed many issues, including concerns about declining male sperm count, diagnosis, risk factors, treatment, and IVF, among many others.
His response is reproduced below:
Declining sperm count and male infertility in Nigeria
”Well, I’m conscious of them and would say they’re genuine. A examine about two years in the past checked out America and (*60*) and stated that sperm rely has lowered within the final forty years by 50%.
‘Also, we conducted research in our clinics; we have clinics in Lagos, Abuja and Asaba. We looked at ten (10) years apart the sperm parameters of men who presented in our clinics, and we saw a 30% decline in the sperm of men who showed up in our clinics in Nigeria.
‘Of course, we can not replace that with the community because it is just a clinic-based study; unfortunately, it also bears credence to what is reported in Europe and America.
It might be fair to say that sperm count globally might be reducing (I am choosing my word with much sense of responsibility), so much that some people said there is something called “spermageddon” because they believe sperm count might be reducing.
Causes of male infertility
One can look at so many factors, but probably one of the elephants in the room is lifestyle. We know that obesity and sperm count do not go together. We know a lot of young men are taking hard drugs these days for different reasons. Some use it for recreational purposes; some use it as an aphrodisiac and weight lifting; some even use these steroids to gain six packs. All these can affect sperm count.
The environment on its own is another factor. We are now talking about global warming. Some people might say the testes were placed outside by God for a reason for it to be cooled and for some of the things that might be warming the environment.
Even the WHO has been lowering the standard; what they considered normal 40 years ago is not what they are saying is normal now. So they have reduced it. That might also be one of the things to show us that sperm count might be going down.
So those are some of the issues, and I think there seems to be a correlation that sperm count might be going down.
Data on Infertility in Nigeria
There’s no knowledge, however that’s one of many issues that the Association of Fertility and Reproductive Health, AFRH, try to do. If you need precise figures, they have to be community-based, not clinic-based.
Don’t neglect that for one to return to the clinic already means he’s sick. It won’t be consultant of what’s occurring in the neighborhood.
I do know some individuals have executed some community-based figures like I noticed WHO saying that 1 out of 6 has infertility usually. However, some figures that some individuals did not too long ago in Nigeria don’t correlate with that. The most necessary factor is just not how widespread it is; we all know it’s widespread, however what can we do to assist individuals affected by these situations?
Has male infertility grow to be a social and a medical difficulty?
Yes, it is just not solely a medical difficulty any extra; it can also be a social difficulty. This is as a result of a number of the interventions we have to take is not going to even be medical, like what we’re doing now, educating the individuals.
One good instance I might at all times cite is that a number of years in the past, after we noticed a male stomach, we did say it was proof of fine dwelling, however now we all know it is just not. And All of us at the moment are operating to the fitness center to verify we trim down as a result of we out of the blue know one is perhaps predisposed to coronary heart illness, hypertension and diabetes.
So the identical method is what we have to do even with these younger males. Sometimes I see a teen who may be very slim, and he takes vodka straight as if the factor goes out of trend, and I have a look at him and shake my head and say, one among lately, this one goes to grow to be my affected person. But as a result of they don’t know, it’s a social drawback and possibly wants social intervention.
Male infertility and prognosis
Infertility is the lack of a pair to conceive or have a dwell child after twelve months.
We have additionally executed it in a method that it is now age-related. We say twelve months if the lady is beneath 35 and 6 months, particularly if she is 37 and above.
So when the trigger is both solely or being contributed to by the person, we name it male infertility. Or you possibly can say infertility is the lack of a person to get his feminine accomplice pregnant.
If you have a look at find out how to make the prognosis, sadly, most instances of male infertility don’t have signs for the person to have a clue that there’s an issue as a result of he can do nearly every thing. He can have intercourse, and he can ejaculate more often than not, however the issue is that the troopers in his brigades won’t simply be sturdy sufficient to have the ability to get the job executed.
I hear many ladies say that they noticed their husbands’ sperm. I don’t know what they need to observe there as a result of the sperm cells reside organisms, and so they transfer. Of course, they’re seen to the strange eyes; however you could use the microscope. So the one take a look at that may let you know about whether or not a person can impregnate his spouse is seminal fluid evaluation, which is the examination of the sperm cells beneath a microscope.
The solely take a look at is seminal fluid evaluation, and on this, we have a look at parameters, we have a look at the quantity of the sperm, we have a look at the rely of the sperm, we have a look at the power to maneuver, we have a look at the morphology, after which we additionally have a look at the presence of white blood cells. The World Health Organisation, WHO, has fastened values for all this for us to know if the sperm rely is regular or not regular.
Treating male infertility
The confirmed simplest methodology for treating male infertility is the process we name Intracytoplasmic Sperm Injection (ICSI), which entails injecting one sperm into one egg, and that’s executed beneath the microscope.
And then, while you fertilise the egg, you switch the fertilised embryo into the lady. The switch may be executed on days two, three or 5. The results of ICSI is pretty much as good as that of IVF.
There have been different spinoffs from the ICSI. Let us think about this, you realize, I stated ICSI entails injecting one sperm into one egg. For you to have the ability to do that, it’s important to amplify the sperm cells to about 200mm so that you’d be capable of see the sperm cells swimming.
The greatest you possibly can see is their swimming; generally, some don’t have a head. They solely have tails to allow them to swim, and also you won’t know they’ve a head, however there’s a gap of their head. You could not know, and you utilize them to fertilise the egg. And as they are saying, rubbish in, rubbish out. If you’ve got used the mistaken sperm to fertilise the egg, the embryo is not going to be okay. And so there is perhaps a being pregnant drawback, otherwise you might need a miscarriage.
Now we began to amplify this sperm past 200mm to about 6000 -7000mm. And due to that, we might see the pinnacle very clearly; we might see the tail and in all places.
This process known as Intracytoplasmic Morphologically Selected Sperm Injection, IMSSI. As the title suggests, “morphologically selected,” we glance for the usually fashioned sperm to inject into the egg.
Then additionally, you realize necessity is at all times the mom of invention. We began seeing that even with this after we first began doing IMSSI, we went “gaga,” pondering that we had discovered eureka, solely for us to see afterward that a few of these sufferers that received pregnant nonetheless had a miscarriage as a result of the sperm was not nice.
So we began wanting for different strategies by which we will display sperm as a result of when you find yourself doing ICSI, the outcomes are based mostly on the standard of the sperm and the standard of the egg. So you could have the strategy that may provide the greatest sperm regardless of how unhealthy the environment are.
And so we began doing Physiological Intracytoplasmic Sperm Injection, PICSI. In PICSI, we checked out why it is that when hundreds of thousands of sperm encompass the egg, it’s one that may enter. We began wanting on the high quality of sperm that might enter. We noticed that it has a particular enzyme richer than different sperms, and that’s why it was capable of enter. So that’s why we referred to as them Physiological ICSI. So we additionally began doing that.
The newest factor on male infertility remedy is DNA fragmentation. All this we do in Nigeria. We see that the one factor the sperm contributes to the equation is the DNA on the sperm head; they alternate DNA at fertilisation with the lady and the person, which come collectively to kind a brand new life.
We found that if man’s DNA has been denatured or damaged down greater than regular, the embryo you may get won’t be top of the range and unable to kind a child. We have now devised a method to check the sperm to see how a lot denaturation has taken place to the DNA; that may be a direct reflection to see how it is for sperm to have the ability to fertilise the egg and develop from the stage of fertilisation to stage 5 of the trimester most likely. And in order that’s additionally one of many issues that we’re doing.
But one different approach that can be utilized to deal with male infertility is to have a look at the genetic composition, for occasion, while you study to see if an embryo is viable.
Does genetics have something to do with male infertility?
We consider that it does. There is infertility that you simply inherit. You can’t reverse it in case you’re created in a technique or one other. However, some means are developing now, for occasion, gene modifying. But it’s such as you need to appropriate somebody with sickle cell too. The gene modifying would most likely get to that, however it’s not reversible proper now.
Rhesus incompatibility doesn’t result in infertility in anyone. It can result in you having miscarriages as a result of the newborn dies. Rhesus incompatibility solely impacts the newborn.
Male infertility is poorly researched, and the end result is just not so nice, however these are a number of the issues we at the moment are engaged on and seeing higher outcomes.
Handling emotional and psychological elements of infertility
I believe many males are coming ahead. Yes, not everybody, however many individuals are coming, and a few causes some males don’t come ahead for remedy are guilt and disgrace.
They are shutting themselves out of actuality, which doesn’t assist anybody. For a few of them, it’s like a defence mechanism. That’s not the best way to deal with any drawback. You can’t shut your self out and get it solved. It is a denial section.
I additionally assume that Nigerians usually don’t make use of counselling. We don’t perceive what counselling means. It’s church counselling that we take.
Sometimes I giggle at church counselling; it is rather like you asking somebody that has by no means been married about marriage. It’s not skilled counselling more often than not, and that’s why some sufferers discover it tough to simply accept skilled counselling as a result of the counselling they used to do is the pastor telling them what to do.
In skilled counselling, the counsellor is meant that can assist you work out how you’ll clear up your drawback. So individuals want to grasp that in case you have an issue and I let you know how I really feel, you possibly can clear up it. I assume that we’re reasoning the identical, we’ve the identical feelings and so forth. It won’t be completely true. Knowledgeable counsellor helps you’re taking your emotions and competencies into cognisance and trend out one thing that matches you.
I believe males ought to begin that; there’s no macho when you’ve got an issue. Even the bible stated on this world, there could be tribulation, there could be bother, be of fine cheer. So there should at all times be bother. It’s not by operating away from it however by going through it head-on and getting the answer.
Does diet have an effect on male sperm high quality?
Yes, it does. Nutrition impacts the standard of sperm as a result of diet is a part of the approach to life.
We are made from what we eat in the end. So there’s little doubt that diet has one thing to do with it. Nutrition additionally has to do with common well being; in case you eat issues that may predispose you to diabetes, diabetes additional even reduces your probabilities of having a child and even a person with the ability to impregnate a girl.
To keep fertile as a person, you have to eat healthily and keep wholesome. The guidelines are the identical, keep away from refined carbohydrates, take extra plant-based protein, and keep away from saturated fat and alcohol. That’s why I stated about way of life decisions as a result of alcohol is just not meals. Alcohol is a giant issue; cigarette smoking is a giant issue; medicine are a giant issue.
Mitigating the dangers in IVF
The biggest mitigation to dangers is coaching for service suppliers. The second one is that what was once the best drawback of IVF earlier than is hyper-stimulation, which is an overreaction to medicine utilized in stimulating the eggs in ladies.
We know usually, a girl produces just one egg each month; generally, she produces two in a month. But in doing IVF, we can’t use one or two eggs, so we rely on medicine to stimulate her to supply extra eggs. What we name that course of is hyper-stimulation.
Some ladies overreact to this hyper-stimulation and produce too many eggs, which might result in ovarian hyper-stimulation syndrome.
This was most likely probably the most dreaded issues in IVF, however I haven’t seen one in ten years as a result of so many clinics now use some drug routine that doesn’t predispose them to that form of scenario. After all, it’s higher prevented than handled.
What is the success fee of IVF?
One of the issues we are saying in IVF or assisted copy, and even copy itself, is that the success fee is individualised. The age of the lady might be an important issue. For occasion, if two have low sperm rely and the spouse of 1 is 25 and the opposite 38, the probabilities of the previous could be higher than the latter.
The second issue will now be the age of the person. The first issue is the age of the lady. So after we speak concerning the success fee, it’s important to take it holistically, and it’s individualised. If you might be lower than 37, usually, the success fee is 35 to 40% within the neighbourhood.
People say it’s low, however I ask them what they evaluate it to as a result of nature by itself delivers 20-25 each month at its very peak. So what we’re even saying is that IvF provides you a greater likelihood than nature.
The fable about male fertility
The fable that ladies are responsible for infertility is a giant fable as a result of about 60% of infertility is as a result of man; it’s solely attributable to him, or he’s contributing.
Men contribute about 60% of the causes of infertility. And that’s why we’ve been saying that if there’s infertility, each the person and the lady must be investigated.
Advice to males affected by male fertility
There’s no various. One has to weigh his choices; what do you achieve by sitting down and never doing something, after which your spouse turns into older? We know that the success fee diminishes with age. So, such males ought to embrace know-how and belief the method. But most significantly, they need to select their clinics correctly. Fertility remedy is just not what you select due to value.
Regulating fertility practices in Nigeria
What is regulated in Nigeria? Nothing is regulated in Nigeria. We have an expert physique, however it’s a voluntary affiliation with no policing energy.
I do know that Lagos State is making an attempt to make some legal guidelines. Once they will do this, I’m positive different states will be capable of comply with.
They are nonetheless making strikes making an attempt to control it, however in fact, every thing is determined by policing.
A phrase for the federal government
The authorities is aware of what to do. We should spend cash. Nigeria was a part of the African Union that agreed they might be spending 15% of GDP on well being, however we’re spending lower than 5%. So every thing is affected.”
