Introduction

“Be fruitful and multiply, and fill the earth…” (Genesis 1:28) is an often-quoted scripture affirming God’s command concerning the blessing of children. Also, in all Nigerian cultures, there is a huge premium put on a couple’s ability to have children yet not all couples are able to conceive and bear children.

Infertility in a male is the inability of the man to impregnate a woman who has no gynecological problems after one year of regular unprotected sexual intercourse. The World Health Organization estimates that worldwide 8-12 million couples experience some forms of infertility. In Nigeria, the exact burden of infertility is difficult to ascertain but different estimates put infertile couples to be anything from 3 – 4 million in number. Some estimates state that Nigeria bears 20% of the infertility burden of Africa.

 Sadly, society often lay the blame for the inability to have children on women ignoring the fact that it takes two individuals to conceive a child. We will consider the causes, treatment and prevention of male infertility in this write up.

Burden of Problem

Although the inability to have children is not a life-threatening condition, it puts a lot of strain on a marriage and may be a cause of depression, divorce and spousal abuse particularly for the female in the traditional African society that blames women when babies aren’t born. Research has shown that the causes of infertility are shared between the female and male sexes and sometimes involve problems in both the men and women.

Male infertility accounts for as high as 40-50% of the causes of infertility, depending on the region of Nigeria. Meaning that, in every ten couples who are unable to have children, 4 - 5 of the men in such couples would be the reason for the inability to have children. The quality and number of sperm a man produces during intercourse is one of the most important factors that determine whether the woman will get pregnant or not. 

Causes of Low Sperm Count

• Heavy Alcohol Intake- Alcohol affects the body’s ability to absorb a micronutrient called Zinc which is essential for the production of healthy sperm. It is not exactly clear what amount of alcohol is too much as it concerns sperm production but it is advisable to stay away as much as possible from alcohol especially heavy drinking.
• Oxidative Stress – Smoking, obesity, diet and exposure to pollutants are all pathways to what is called oxidative stress which affects the quality and number of sperm cells. Obesity around the abdomen particularly has many other health implications including diabetes which could cause erectile problems and affect male fertility adversely.
• Untreated/poorly Treated Sexually Transmitted Infections: When sexually transmitted infections are not treated or poorly treated, it could result in male infertility. This includes infections such as gonorrhea, syphilis and chlamydia as well as Mumps which causes sterility.
• Exposure to Heat: Sperm is produced in the testis which is contained in the scrotal sac that maintains a constant temperature 1 0C – 2 0C below the core body temperature of 37 0C that is necessary for the production of sperm. Certain electronic devices such as laptops and even cell phones emit heat that can affect this process and cause a reduction in sperm cells. Tight underpants keep the temperature in the male private area high as well and may have the same adverse outcome.
• Exposure to Pesticides and Environmental Pollutants: Exposure to pesticides and some agricultural chemicals have been shown to affect sperm production. This also applies to some paints, adhesives and coatings. Appropriate protective gear is therefore essential for men exposed to such chemicals in their line of work. This also applies to sources of toxic metals such as Lead and Mercury which bio accumulate in food exposed to pollutants.
• Recreational Drug Abuse: Drugs such as Cannabis (popularly called Hemp) has a dramatic effect on sperm causing them to swim too fast and burn out before fertilizing the female egg after intercourse.
• Poor Diet: A healthy diet promotes good sperm quality while a poor one has the opposite effect. Diets rich in carbohydrates, fruits, vegetables and other sources of fibre significantly improve sperm quality while consumption of large amounts of fat and animal proteins affect sperm negatively.
• Erectile Dysfunction- This is the inability of a male to have and sustain an erection. This contributes to male infertility and has a prevalence of about 50.7% in Nigerian men attending primary care clinics. It is a great source of embarrassment to men so it is hardly spoken about because it affects a man’s perception of his masculinity. It tends to increase with age from the age of 40 but is related to obesity, diabetes mellitus, hypertension, excessive consumption of caffeine found in drinks such as coffee as well as smoking and alcohol use. There are also hormonal abnormalities that cause erectile dysfunction.

It is wise therefore for men to take note of these things so that choices made in youth or from peer pressure won’t affect their chances of having children when they are ready later in life.

• Age: Fertility is generally known to peak and decrease with age. This is true for men as it is for women. In men the male sex hormone testosterone which increases the sex drive and controls sperm production decreases from the age of 35 – 40 years, men have biological changes that drastically reduce the quality of sperm they produce and their ability to impregnate a female. When men are above 45 years, there is an even lower chance of impregnating a woman.

Prevention

The prevention of male infertility includes lifestyle modification in terms of regulating alcohol intake, drug abuse and a healthy diet rich in fruits and vegetables. Abstaining from premarital or extramarital sex also helps because it reduces the risk of acquiring sexually transmitted infections that affect sperm quality and count. Sexually transmitted infections when they do occur must be treated by a qualified medical practitioner, otherwise, they may persist and damage the ability to produce sperm.

Management of Male Infertility

Generally, the mainstay of management of male infertility is identifying the cause through history taking, examination and investigations. Counselling, hormonal and drug therapy and sometimes even surgical intervention is necessary depending on the cause.

 The chances of a favorable outcome will depend on how long the problem has persisted, the age of the man and the fertility status of the female partner. 

 Lifestyle modification is helpful where there is alcohol, smoking or drug use. Weight reduction for those who are obese can improve sperm quality and count. Reduction of occupational exposure to heat sources, the use of loose-fitting underwear and antioxidants such as Vitamin E, A, Zinc and Selenium as well as treating infections where present can improve sperm count in some men.

Where these fails, there is the option of assisted reproductive techniques such as sperm extraction techniques and in vitro fertilization, which is fertilization of an egg outside of the body with appropriately prepared sperm and later implantation into the uterus after some hormonal priming. There is nothing in scripture against harvesting of eggs or sperm to help child bearing. God is still in control even if the process of reproduction is assisted by man with the knowledge God gave him.

These are however very expensive treatments and beyond the reach of the average Nigerian couple and are not covered by health insurance. The government and donor agencies therefore need to assist in treating infertility generally and also male infertility by making it more accessible in government facilities with Public, Private Partnership.

Conclusion

Male infertility accounts for as much as half (50%) of causes of infertility. The major causes are Sexually Transmitted Infections, and hormonal abnormalities. Appropriate identification and diagnosis are key but is often hampered by the unwillingness of the male folk to present to a specialist for consultation.

The examples of godly men in the Bible who were involved in relationships where there were fertility problems are instructive. Abraham was content with Sarah until she pushed Hagar, her maid to him. Jacob and Elkanah loved their wives despite fertility problems (Genesis 29: 30 and 1 Samuel 1:8).