More often than not, infertility in marriage is often blamed on the woman. African beliefs confound the problem by laying the whole responsibility of childbearing alone on the woman. Medical facts have, however, revealed that the man also might be the reason behind a couple's inability to conceive.
In general, infertility is defined as not being able to get pregnant after one year of unprotected sex. Medical research grouped infertility into two categories: primary infertility refers to couples who have not become pregnant after at least one year of unprotected sex and secondary infertility refers to couples who have been pregnant at least once, but never again.
Experts have revealed that pregnancy is the result of a process that has many steps such as:
• A woman's body must release an egg from one of her ovaries, in a process called ovulation.
• A man's sperm must join with the egg along the way, in a process called fertilisation.
• The fertilised egg must go through a fallopian tube toward the uterus
• The fertilised egg must attach to the inside of the uterus (implantation).
Infertility may result from a problem with any or several of these steps, signifying that sterility is not one-sided alone. That is the more reason why awareness needs to be continually created to dissuade the abuse of women who are considered barren by both family and the society at large.
A consultant obstetrician/gynaecologist with Havana Specialist Hospital, Lagos, Dr Amayo Osakponmwen, described the peculiarities that could lead to a couple being infertile thus: "If a couple have been having regular unprotected intercourse for the past 12 months and they have not been able to achieve pregnancy, then you could say that infertility exists. There are people, who because of their peculiar characteristics, do not need to wait for the traditional 12 months before seeking for medical help. Example of such is a woman who is more than 35 years old; where the woman has had history of certain gynaecological surgeries might have issues with fertility; those ones you cannot wait for 12 months before you begin treatment. In other words, if someone has obvious risk factors for infertility, you may not need to wait for 12 months to begin treatment. But by and large, we still use the 12 calendar months to ascertain infertility in couples."
Is infertility just a woman's problem then? "Infertility is a shared responsibility between couples. It could be a problem from the man or the woman or problem with both. In 35 per cent of the cases, the problem will be with the man, another 35 per cent it is with the woman, and then in 20 per cent, they will share among them. The remaining 10 per cent is unexplained infertility, where you have run all kinds of test yet you cannot say why the couple cannot conceive. That is why it is essential for both the man and the woman to come in together and get examined by a gynaecologist so as to determine what could be the cause of the problem which can stem from either or both of them," the medic said.
For male infertility, experts reveal that the sperm plays a very large role in determining if a man can get a woman pregnant or not. Men often experience infertility issues owing to sexual function disorders and low or no sperm production.
According to the United States National institute of Health, this problem could either be a decrease in sperm count, sperm being blocked from being released or that it does not work properly.
This inability of the sperm to function properly could be as a result of various factors such as: lifestyle, i.e. being overweight or having a job that involves contact with chemicals or radiation. It could also be a direct cause of environmental pollutants; being in high heat for prolonged periods; birth defects; heavy use of alcohol, marijuana, or cocaine; too little or too much hormones; impotence and infection. Others are older age; cancer treatments, including chemotherapy and radiation; scarring from sexually transmitted diseases, injury or surgery; surgery to prevent pregnancy (vasectomy), or failure of vasectomy reversal; retrograde ejaculation and smoking
All these causes have an adverse effect in sperm production in male resulting in problems such as: low sperm count or quality; problems with the tubes carrying sperm; of getting an erection, and that of ejaculating.
Dr Osakponmwen explained that infertility in men is typically evaluated by a semen analysis. "A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). The main problem in the man is abnormal semen quality. A man's semen is a liquid suspension of living spermatozoa. So the most important thing in the ejaculate is the living spermatozoa within it. Common problems with semen involve sperm count, motility, and morphology. If the count is less than 20 million/ml, we will say the man has low sperm count. In some cases, there may be no sperm cell seen (i.e. even though the man produces semen yet nothing inside). It is not only about numbers, the sperms have to swim to meet the egg; this is what is called motility. The sperm morphology looks at the structure of the individual sperm cell; do they look normal or do most look abnormal like having two heads or no tail? He revealed.
The medical expert stressed that in most cases the man has no symptoms of being infertile other than pregnancy not occurring after 12 months of having unprotected sex with the wife. There may be a history of sexually transmitted infections (STI's), groin or hernia surgeries, excessive alcohol or tobacco use, post-pubertal mump, testicular diseases and/or surgery as in childhood undescend testis. Some may be on some drugs like some steroids and cytotoxics. Some people are also born with a genetic/chromosomal abnormality. These cases can be diagnosed with genetic testing.
In the diagnosis and treatment of infertility in men, the gynaecologist will require that the man provide a semen analysis. To get the best result, the man must abstain from sexual intercourse for three days before providing the sample. Genetic blood test is performed to make sure that there are no chromosomal abnormalities or defective genes that could be passed on to potential offspring and blood tests also may be taken to determine levels of testosterone.
Dr Osakponmwen reassured that a slightly abnormal semen analysis does not mean that a man is necessarily infertile. "Instead, a semen analysis helps determine if and how male factors are contributing to infertility," he said.
He added: "Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by an urologist who specialises in infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilisation (IVF) to help overcome male factor infertility."
