Male infertility: The elephant in the room

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A couple enters my office and the husband blurts out that he has brought his wife for treatment as they’ve been infertile for two years. He wants his wife tested and her problem hopefully solved as the family was starting to “talk”. After much persuasion, the couple agrees to clinical tests and lo and behold the problem was found to be with the husband, not his wife.

In Namibia, infertility is a widespread problem, with about 10% of couples experiencing problems conceiving. A couple is infertile when they fail to conceive after more than a year while having regular, unprotected intercourse.

The primary type of infertility is when a couple does not have a child between them, while secondary type is when they fail to conceive more children after having previously conceived. About a third of fertility problems are female-related, another third are male related, and the last third is due to issues with both members of the couple or unclear.

Although most men with male infertility do not notice symptoms other than the inability to conceive a child, some signs and symptoms, while not common, can include swelling or a lump in the testicle area, abnormal breast growth (gynecomastia), reduced sexual desire, or difficulty maintaining an erection (erectile dysfunction).

The process of male fertility is complex, and obtaining a definitive diagnosis and treating the problem even more challenging. A man’s fertility generally relies on the quantity and quality of his sperm; low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm are all considerations.

Illnesses, injuries, chronic health problems, lifestyle choices and other factors play a role in causing male infertility.

Risk factors for male infertility include:
• Sexually transmitted infections (STIs), which can cause scarring in the male reproductive system or impair sperm function. This is the most common risk factor in Namibia.
• Torsion (twisting of the testis in scrotum) occurs usually at an early age.
• Undescended testes (failure of the testes to descend at birth).
• Ageing, which can reduce sperm counts and motility and decrease the genetic quality of sperm.
• Lifestyle factors such as smoking, substance abuse and alcohol.
• Long-term or intensive exposure to certain types of chemicals, toxins, or medications such as anabolic steroids.
• Varicocele, an enlarged varicose vein in the spermatic cord.
• Having a prior vasectomy or major abdominal or pelvic surgery.
In addition to a comprehensive medical history and physical exam, your doctor might perform the following tests: semen analysis to evaluate the quantity and quality of sperm, blood tests to evaluate hormone levels, imaging tests including ultrasound to look for structural problems, and genetic testing.
Treatment for male infertility addresses first any underlying medical conditions that may contribute to fertility problems. Drug therapy may be used to treat hormonal disorders or infections. Surgery may be used to repair varicocele and correct any obstructions in the reproductive tract. Assisted reproductive technology may be used in difficult cases. Assisted reproductive technology (ART) treatments involve obtaining sperm through normal ejaculation, which is then inserted into the female genital tract, or used to perform in vitro fertilization. Currently Dr Kimberg, a gynaecologist in Namibia, offers ART treatments in Windhoek.
The American Society for Reproductive Medicine recommends:
• A couple’s best chance for conception is to have sex 2 to 3 times throughout a woman’s cycle and every 1 to 2 days during a woman’s “fertile window” (the 6 days leading up to and including ovulation).
• Avoid using water-based sexual lubricants (KY gel) as they can interfere with the sperm’s ability to swim. Use instead canola oil, mineral oil
• If you smoke, stop. Smoking may impair sperm quality, as can excessive alcohol use, recreational drugs, and anabolic steroids. It is also important to take care of your overall health, including managing any chronic health conditions such as high blood pressure and diabetes.
Just as conception takes two, consulting a doctor on infertility must involve the same two people from the start. Next week I will be talking about female infertility.

• Dr B Chaka may be contacted at bchaka2000@yahoo.co.uk or 065 251373

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