Infertility is the inability of a couple to procreate or bear children after one year of regular unprotected intercourse. Studies have revealed that the rate of infertility has been on the rise late and this is brought about by a wide range of physical and emotional factors. Men are often overlooked when it comes to the issue of infertility. Although men are often not as expressive about the impact of infertility unlike women, husbands contribute just as much to the causes of infertility as their wives. Male infertility is the inability of a man to fertilize a woman’s egg due to problems specially related to the man’s sperm, seminal fluid, or reproductive organs, and quite a number of couples are still expecting today because of the challenges coming from the man. In this report, BOLA AKINBOADE spoke with Dr Efena Efetie of Dove Fertility Centre, Abuja, who gave an overview on this problem plus the way out. Below are some of the causes of infertility.

LOW SPERM COUNTS
Low Sperm Count is the commonest cause of infertility in men. Men with low sperm find it difficult to impregnate their wives. A sperm count of less than 20 million/ml is considered low sperm. Azoospermia refers to the complete absence of sperm cells in the ejaculate, and accounts for 10 – 15% of cases of male infertility. Partial obstruction anywhere in the long passages through which sperm pass can reduce sperm counts. Sperm count varies widely over time, and temporary low counts are common. It is caused by infections but a lot of people are also born that way. Some people inherit low sperm count.

POOR SPERM MOTILITY (ASTHENOSPERMIA)
Sperm Motility is the sperm’s ability to move. If movement is slow, not in a straight line, or both, the sperm have difficulty invading the cervical mucous or penetrating the hard outer shell of the egg. If 60% or more of sperm have normal motility, the sperm is at least average in quality. If less than 40% of sperm are able to move in a straight line, the condition is considered abnormal. Sperm that move sluggishly may have genetic or other defects that render them incapable of fertilizing the egg. Poor sperm motility may be associated with DNA fragmentation and may increase the risk for passing on genetic diseases.

ABNORMAL SPERM MORPHOLOGY (TERATOSPERMIA)
Morphology refers to shape and structure. Abnormally shaped sperm cannot fertilize an egg. About 60% of the sperm should be normal in size and shape for adequate fertility. The perfect sperm structure is an oval head and long tail.

RETROGRADE EJACULATION
Retrograde ejaculation occurs when the muscles of the bladder wall do not function properly during orgasm and sperm are forced backward into the bladder instead of forward out of the urethra. Retrograde ejaculation is sometimes referred to as a “dry orgasm.” Retrograde ejaculation is not life threatening but is one cause of male infertility. Men often notice during masturbation that they do have an orgasm but there is no semen production. Another underlying cause for this phenomenon may be ejaculatory duct obstruction. Sperm quality is often impaired. Retrograde ejaculation can be the consequence of several conditions: Surgery to the lower part of the bladder or prostate (the most common cause of retrograde ejaculation) , Diseases such as diabetes and multiple sclerosis ,Spinal cord injury or surgery ,Medications such as tranquilizers, certain antipsychotic, or blood pressure medications also may cause temporary retrograde ejaculation, ageing

TESTICULAR CANCER
Testicular cancer develops in the testicles, a part of the male reproductive system.It is most common among males aged 15–40 years. A man with one remaining testis can lead a normal life, because the remaining testis takes up the burden of testosterone production and will generally have adequate fertility. However, it is worth the (minor) expense of measuring hormone levels before removal of a testicle, and sperm banking may be appropriate for younger men who still plan to have children, since fertility may be lessened by removal of one testicle, and can be severely affected if extensive chemotherapy and/or radiotherapy is done.Less than five percent of those who have testicular cancer will have it again in the remaining testis. A man who loses both testicles will normally have to take hormone supplements (in particular, testosterone, which is created in the testicles), and will be infertile, but can lead an otherwise normal life.

SEXUALLY TRANSMITTED DISEASES
Some Sexually Transmitted Diseases (STD) can have serious effects on the reproductive system, especially if they are left untreated. Unfortunately, because many STDs cause only minor symptoms, many infected men do not get the necessary treatment. As a result, a large number of people suffer the effects of STD-induced infertility. The majority of men who are infected with an STD exhibit symptoms soon after infection.

Gonorrhea and Chlamydia are the two most common causes of STD-related infertility.

Such infections can cause scarring and block sperm passage. Human papilloma viruses, the cause of genital warts, may also impair sperm function. Also Epididymitis causes inflammation in the one of the vessels which transports semen from the testicles. Epididymitis can result in the complete blockage of these vessels, causing male infertility.

STRUCTURAL ABNORMALITIES
Any structural abnormalities that damage or block the testes, tubes, or other reproductive structures can have a profound effect on fertility. These include:

Cryptorchidism: Cryptorchidism is a condition usually seen in newborn infants in which the testicles fail to descend from the abdomen into the scrotum. Cryptorchidism is associated with mild to severe impairment of sperm production.

Hypospadias: This is a birth defect in which the urinary opening is on the underside of the penis, it can prevent sperm from reaching the cervix if not surgically corrected.

Blockage in the Tubes that Transport Sperm: Some men are born with a blockage in the epididymis or ejaculatory ducts or other problems that later affect fertility. Some men lack the vas deferens, the tube that carries sperm from the testicles out through the penis. Low semen levels in ejaculate may be associated with structural abnormalities in the tubes transporting the sperm.

HORMONAL DEFICIENCES
Hypogonadism is the general name for a severe deficiency in gonadotropin-releasing hormone (GnRH), the primary hormone that signals the process leading to the release of testosterone and other important reproductive hormones. Low levels of testosterone from any cause may result in defective sperm production.

Hypogonadism is uncommon and is most often present at the time of birth, usually the result of rare genetic diseases affecting the pituitary gland that may include selective deficiencies of the hormones FSH and LH, Kallman syndrome, or panhypopituitarism, in which the pituitary gland fails to make almost all hormones. It can also develop later in life from brain or pituitary gland tumors or as a result of radiation treatments.

VARICOCELE
Varicocele is an abnormally enlarged and twisted (varicose) vein in the spermatic cord that connects to the testicle. Varicoceles are found in about15% of all men and in about 40% of infertile men, although it is not clear how much they affect fertility or by what mechanisms. They can raise testicular temperature, which may have effects on sperm production, movement, and shape.

AGE
Age-related sperm changes in men are not abrupt, but are a gradual process. Ageing can adversely affect sperm counts and sperm motility (the sperm’s ability to swim quickly and move in a straight line). The genetic quality of sperm declines as a man ages. Semen quantity peaked between the ages of 30 and 35, while overall semen quantity was found to be lowest after age 55. They also found that sperm motility – in other words, how well the sperm swim – was best before age 25 and lowest after age 55. In fact, when comparing the number of “good swimming” sperm in men between the ages 30 to 35 with men over age 55, sperm motility decreased by 54%. Besides low-quality semen, age also affects the genetic quality of male sperm, genetic defects in the sperm increase with age in men, possibly leading to decreased fertility, increased chance of miscarriage and increased risk of some birth defects.

STRESS
Physical as well as emotional stress are known to affect the fertility. Stress is like a runaway train that gathers momentum with time. Stress can make men less fertile by its effect on the hormones and reproductive organs. Sperm counts, motility, and structure are altered under stress. Problems such as impotence and difficulties with ejaculation are often caused by the emotional distress in men. Stress can Lead to Infertility – This, in turn can lead to increased stress leading to a vicious circle

SMOKING AND DRINKING
There is no doubt that smoking and drinking can lead to infertility. This is because when you smoke and drink, your blood circulation decreases, your sperm count also decreases. Cigarette smoking also affects sperm quality. Also Substance Abuse such as Cocaine or heavy Marijuana use can temporarily reduce the number and quality of sperm. Sperm actually have receptors for certain compounds in marijuana that may impair the sperm’s ability to swim and also inhibit their ability to penetrate the egg. Anabolic steroid use can shrink testicles and decrease sperm production.

BEING OVERWEIGHT
When you are overweight, which obviously is due to lack of exercise and overfeeding not only causes various heart ailments, but also infertility. Being overweight can lower sperm count.

EXPOSURE TO TOXINS AND CHEMICALS
Occupational or other long-term exposure to certain types of toxins and chemicals (such as herbicides and pesticides) may reduce sperm count by either affecting testicular function or altering hormone systems. Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect sperm quality.

MEDICAL CONDITIONS
Medical conditions that can affect male fertility include any severe injury or major surgery, diabetes, HIV, thyroid disease, Cushing syndrome, heart attack, liver or kidney failure, and chronic anemia. Certain types of medications can impair sperm production.

Infections in the Urinary Tract or Genitals; infections that may affect fertility include prostatitis (inflammation in the prostate gland), orchitis (in the testicle), semino-vesculitis (in the glands that produce semen), or urethritis (in the urethra), perhaps by altering sperm motility. Even after successful antibiotic treatment, infections in the testes may leave scar tissue that blocks the epididymis.

Cancer and its treatments; birth rates among cancer survivors are only 40 – 85% of normal rates. Certain cancers, particularly testicular cancer, impair sperm production, often severely. Cancer treatments such as chemotherapy and radiation can damage sperm quality and quantity, causing infertility. The closer radiation treatments are to reproductive organs, the higher the risk for infertility.

A DOCTOR VIEW
City People spoke to Dr Efena Efetie of Dove Fertility Centre, Abuja. Dr Efena Efetie is a renowned gynecologist and one of the leading fertility experts in the country. He also gave a very extensive overview on why many men cannot impregnate their wives plus the way out.

THE GENERAL FACTORS
There are general factors responsible for men’s inability to impregnate their wives. And these factors affect sperm production, sperm release as well as sperm function. While talking generally, it is good to mention that there are elements of chance that there that the man will impregnate his wife each month. The chance for normal fertile couple is one in 6. So there maybe nothing wrong if the man is not able to impregnate his wife except if it’s over a long time. The other factors are the timing and frequency of intercourse; maybe he is not meeting the wife at the right time. Because of ovulation, the woman is more receptive to receive than a man. So the timing may not be at the right time, that is, meeting her at the wrong time of menstrual cycle.

The other reason is frequency of intercourse, maybe they are not meeting adequately. These 2 factors are quite important because ovulation occurs just once in a month and if they don’t catch the egg at the right time, that is it.

LIFESTYLE FACTORS
Other reasons are lifestyle factors, like smoking, moderate and heavy alcohol consumption, because all these have negative effects on sperm and egg quality and affects fertility in general. Nicotine in Alcohol is not too good to the sperms and eggs.
Other lifestyle factors are being overweight and obesity; this may affect man’s ability to impregnate the wife, because they are more likely to have high blood pressure and diabetes.

MEDICAL PROBLEMS
This is different from lifestyle. These include; High blood pressure, diabetes, thyroid disease. These affect the men either through the disease or through the medication.

Testicular infection can be a reason why men cannot impregnate their wives.

If he has viral infection like mumps, this will cause Orthipis, and this could destroy the sperm ducts that produce sperm in the testes.
If it is a bacteria, that can cause blockage of the main ducts, van deferens, and epididymis, then sperm will not be able to come out.
Then another class is surgical operation especially if they were done in childhood to correct hernias, or descended testes or torsion of the testes. These operations are okay but if they were done by inexperience or in the wrong hands, complication will arise and blood supplied to the tests will be compromised and the men will have very low sperm count or none.

Effect on some medication for men, e.g medication to treat blood pressure like ACE Inhibitors and others. There are other medications like extensive use of NSABS, it’s a group of drug for pain and arthritis, and can effect sperm count and function. Drug abuse that is use of anabolic steroids, abuse of marijuana

SPECIFIC PROBLEMS
This can be rated in terms of production, sperm release and sperm function
Production: any illness that causes severe prolong fever, and it is prolonged will affect production. Exposure to toxic substance or chemicals, as well as environment pollution, also affect sperm production. Exposure to recreational such as body building will affect sperm production.

Chromosomal disorder, that if a man has XYZ chromosomal abnormalities, you are very likely to have very little sperm or none at all. They are just born like that.

Sperm release: the number one problem that causes release of sperm is infection and the common ones are Gonorrhea, Syphilis, Chlamydia, anaerobic bacteria. It causes blockage of the block, so the tube that are suppose to carry the sperm and release into vagina are blocked.

The other reasons are that when some undergo operation around their groin, they can have complication either testicular or scrotum. If there is complication and they are infected, they can have blockage of duct and problem with sperm release
Sperm function: infection and lifestyle affects sperm function.

WAY OUT

• Seek help from your gynecologist

• The treatment is directed to the cause, for simple things like lifestyle, you just need to adjust the negative lifestyle in terms of alcohol, tobacco. You reduce their consumption.

• If it’s a medical problem like high blood pressure, diabetes, you may just need to stabilize the high blood pressure and sugar level. Adjusting your medication to address this issue.

• if its infection, treat with appropriate antibiotics

• If its sperm function, there is some treatment that men can get to help the movement or the abnormal shape; there are some treatments in terms of drugs that will help the morphology apart from count.

• Some men who has low sperm count , they may not be able to impregnate their wives, that is when assisted conception comes in, that is, intra uterine insemination

• And in very severe abnormalities, the best treatment is IVF.