Fatherhood, once taken for granted, has become a seemingly unattainable goal for increasing numbers of men worldwide.
This phenomenon is not limited to developed countries as recent studies have reported a significant prevalence of male factor infertility in sub–Saharan Africa.
This decline in fertility rates gives rise to social challenges, particularly the aging population phenomenon. In a study published in 2020, researchers employed a statistical model, known as the Cohort-Component Fertility Model at Age 50 (CCF50), to project future total fertility rates across the global population.
The study predicted that by the year 2100, a total of 183 countries will have fertility rates below replacement levels. The global forecast for 2100 indicates that the population of individuals aged 65 and above will be 1.3 times greater than the population of individuals under the age of 20. This demographic shift resulting from low fertility rates will have significant adverse implications for global development.
Alarmingly, a study aimed at identifying the prevalence, and trends of male factor infertility in Nigeria and South Africa over a period of ten years between 2010 and 2019 found that significant trends of decreasing values were observed in normal sperm morphology, progressive motility, and the ejaculatory volume, indicating a progressive deterioration of these values in both countries.
In addition, in many Sub-Saharan cultures, male infertility is often stigmatized and viewed as a personal failure, shameful, and a sign of weakness.
Traditional beliefs and societal expectations emphasize masculinity and fatherhood, making infertility a sensitive topic. Some common perceptions include beliefs in witchcraft or curses as causes of infertility; shame and embarrassment for the individual and family; fear of social ostracism and loss of status; expectations on men to prove their virility through fatherhood; and limited understanding and discussion of issues regarding infertility.
The stigma often extends to the female partner, assuming female infertility or wrongdoing.
These cultural attitudes can lead to delayed seeking of medical help; increased psychological distress; marital and family conflicts; and social isolation.
However, there is a growing movement to raise awareness, reduce stigma, and promote support for male infertility in Sub-Saharan Africa.
Bridge Clinic is making significant strides in addressing male infertility in Sub-Saharan Africa through a multi-faceted approach that focuses on raising awareness, reducing stigma, and promoting support.
Bridge Clinic organises forums, programs and workshops to educate couples about the importance of reproductive health and regular check-ups, which helps in early detection and treatment.
By facilitating open discussions about male infertility, Bridge Clinic helps to normalize the conversation, making it easier for men to talk about their issues without fear of judgment.
Bridge Clinic also offers professional counselling services to help men and couples cope with the emotional and psychological impacts of infertility.
Bridge Clinic provides a holistic approach to treatment, which includes lifestyle advice, nutritional counselling, and stress management, catering to the overall well-being of our patients.
Through these comprehensive strategies, Bridge Clinic is playing a pivotal role in changing the narrative around male infertility in Sub-Saharan Africa, fostering an environment where men feel supported and empowered to seek help.
Male factor infertility, a common reason for delays or difficulties in conception, is the inability of a male to make a fertile female pregnant after a minimum of one year of regular unprotected intercourse, primarily due to poor sperm quality.
Sperm, also known as spermatozoa, are the male reproductive cells in sexual reproduction.
They are produced by the testicles in the male body. The process of sperm production is called spermatogenesis. This process takes around 70-80 days, and the body produces millions of sperm daily.
Hormones like testosterone and follicle-stimulating hormone (FSH) regulate spermatogenesis which begins during puberty and continues throughout the man’s life although the quality and quantity of sperm produced declines with age. The age at which this decline starts and the rate at which it progresses can vary significantly between individuals.
The following are some general guidelines
Age 40-50: Sperm quality and motility may start to decline, making it more difficult to conceive.
Age 50-60: Sperm count and quality decline more significantly, increasing the risk of birth defects and miscarriage.
Age 60+: Sperm quality and motility decline substantially, making it challenging to conceive naturally.
These are general trends, however, and individual variations are significant.
Lifestyle factors, medical conditions, and environmental exposures can also impact sperm quality.
Male infertility is diagnosed by a healthcare provider who will review the man’s health history and perform a physical examination.
Other tests for male infertility may include semen analysis, blood tests to check hormone levels and rule out other problems, and imaging tests to examine the testicles, blood vessels, and other structures inside the scrotum.
Some individuals may be more at risk of male infertility if they have had past inflammation of the prostate or past genital infections, injury to or twisting (torsion) of the testicles, early or late puberty, exposure of the genitals to high temperatures, hernia repair, or undescended testicles.
Certain prescription medicines including medicines for ulcers, psoriasis, depression, and high blood pressure can also increase the risk of male infertility.
Symptoms of male infertility include, but are not limited to, the inability to conceive after one year of unprotected intercourse, erectile dysfunction, painful ejaculation, reduced sexual desire, testicular pain or swelling, and breast tenderness or enlargement.
Problems with making healthy sperm are the most common causes of male infertility. Sperm may be immature, abnormally shaped, or unable to swim. In some cases, the man may not have enough sperm (Oligozoospermia, defined by the World Health Organization as a sperm concentration of less than 15 million per milliliter) or he may not produce any sperm (Azoospermia).
This problem can be caused by many different conditions, including infections or inflammatory conditions. One example is infection with the mumps virus after puberty.
Hormone or pituitary gland problems such as Hypogonadism (low testosterone) which impact sperm production and quality, also affect male fertility as well as tumors in the pituitary gland which can affect hormone regulation, impacting sperm production.
In rare cases, the man may have immune problems in which he makes antibodies against his own sperm. This is known as Autoimmune Infertility or Antisperm Antibodies (ASA). This occurs when the immune system mistakenly recognizes sperm as foreign and attacks them, producing antibodies to neutralize or destroy them.
Lifestyle factors including tobacco use, heavy alcohol use, and steroids have been shown to negatively sperm quality. Alcohol consumption has a more pronounced effect on reducing sperm maturity and causes more DNA damage than smoking.
Increasingly, research suggests that environmental endocrine disruptors (EDCs) play a significant role in the development of male infertility by creating the conditions that can lead to testicular hypoplasia syndrome, which is one mechanism that affects male fertility.
EDCs are chemicals in the environment that can interfere with the body’s endocrine system, which regulates hormones. These substances can mimic or block the effects of hormones, leading to changes in development, growth, and function.
Common examples of EDCs include pesticides such as DDT; some plastics like BPA and phthalate; heavy metals including lead and mercury; personal care products which contain parabens and triclosan; and industrial chemicals, particularly PCBs and dioxins.
Furthermore, EDCs may have substantial effects on reproductive function in embryos and can have long-lasting impacts on offspring.
Genetic diseases, such as cystic fibrosis (CF) can affect male fertility in several ways. CF can cause the vas deferens to be blocked or absent, preventing sperm from leaving the body during ejaculation. CF can also affect sperm quality and motility, making it harder for sperm to fertilize an egg. Men with CF may have a lower sperm count than average.
CF can cause semen to enter the bladder instead of the penis (retrograde ejaculation) during ejaculation and disrupt hormonal balances, affecting fertility. CF can also increase the risk of testicular damage due to inflammation and infection.
Hereditary problems like hemochromatosis, a disorder that causes the body to absorb excessive iron, leading to iron accumulation in the body and damage to organs can affect male fertility in several ways, including lower sperm production, sperm dysfunction affecting sperm motility and morphology, hormonal imbalance, testicular damage, erectile dysfunction, and reduced libido.
Anything that blocks the genital tract can stop the flow of semen and prevent conception. This could be a genetic or birth defect or an infection or inflammation from a sexually transmitted disease.
Other causes include scar tissue from surgery or twisted, swollen veins in the scrotum.
Fertility clinics evolved to meet these challenges and, although issues relating to female infertility have received widespread attention, several treatment options have been developed to specifically address male infertility.
Hormone therapy and medication treats hormonal imbalance and infections like prostatitis, epididymitis and orchitis. Surgery treats varicoceles, blockages, and retrograde ejaculation.
Assisted reproductive technology (ART), which includes intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), and sperm donation, treats decreased sperm mobility, Oligozoospermia and Azoospermia.
Bridge Clinic takes a comprehensive approach to treating couples with male factor infertility which begins with a thorough review of both partners’ medical histories.
A physical examination, especially for the male partner in this case, will assess any physical anomalies that might affect fertility.
Several laboratory tests are taken including semen analysis to evaluate sperm count, motility, morphology, and other factors as well as hormonal assays to check levels of testosterone, FSH.
Recommendations are made for a healthier lifestyle which may include diet changes, reducing alcohol intake, quitting smoking, managing stress, and weight management.
Hormonal treatments or medications that can improve sperm quality or address infections and inflammations may be used.
Intrauterine Insemination (IUI) in which sperm is washed and concentrated before being placed directly into the uterus, is often used when mild sperm issues are present.
In Vitro Fertilization (IVF) where eggs and sperm are combined in a laboratory setting, allows for fertilization outside the body.
In some cases, Intracytoplasmic Sperm Injection (ICSI) a process by which a single sperm is injected directly into an egg, is employed. This is particularly useful in instances of very low sperm count or poor sperm motility.
Sperm retrieval techniques such as Testicular Sperm Extraction (TESE) or Microsurgical Epididymal Sperm Aspiration (MESA) can retrieve sperm directly from the testes or epididymis.
Psychological counselling is provided to help couples cope with the emotional stress of infertility treatments.
Bridge Clinic blends these medical and supportive approaches to offer tailored fertility solutions, helping couples achieve their dream of parenthood
There are several lifestyle changes men can make to help prevent infertility. These include maintaining a healthy BMI, exercising regularly, avoiding tobacco, excessive alcohol consumption, and exposure to toxins.
Men should keep the scrotum cool by avoiding tight clothing, hot tubs, and saunas, which can increase scrotal temperature and negatively impact sperm production. Excessive cycling or biking places prolonged pressure on the perineum which can also affect sperm quality.
High stress levels can affect hormone balance and sperm quality. Meditative techniques such as yoga can help to manage stress as well as 7-8 hours of sleep per night.
Several recreational drugs have been linked to male infertility, including marijuana, opioids such as heroin and fentanyl, cocaine, amphetamines (methamphetamine), and MDMA (ecstasy), all of which can decrease sperm count, motility, and increase abnormal sperm morphology.
The use of anabolic steroids such as testosterone, dianobol and nandrolone can significantly impact male fertility, leading to oligospermia or azoospermia, shrunk testicles (testicular atrophy), breast tissue growth (gynecomastia), reduced libido and erectile dysfunction.
It is essential to note that the effects of recreational drugs on male fertility can be temporary or permanent, depending on the drug, duration of use, and individual factors. Quitting drug use can often lead to improvements in fertility while certain supplements like zinc, vitamin D, and omega-3 fatty acids help support sperm health.
Wherever possible, men should limit their exposure to EMFs (electromagnetic fields). Some studies suggest that excessive exposure to EMFs from devices like laptops and cell phones may affect sperm quality.
Although some causes of male infertility are unavoidable, getting regular health check-ups as well as following the tips mentioned above can help identify potential issues early on and reduce their risk.
Olumuyiwa Eleshinla is the Head of Commercial, Bridge Clinic
