for short this is still not the worst that
can happen. Some samples have no sperm
at all – azoospermia. Such patients have
to undergo tests to confirm if the sample
has no sperm because of a block in the
tubes that take sperm from testes to penis
(vas) and this is known as obstructive
azoospermia or the patient has a problem
with production of the sperm Non-
obstructive azoospermia.
Dealing With Male Sub-
Fertility
With all these different problems how
do we deal with male sub-fertility? Great
question. Fortunately with the advances in
medicine what were once lost causes now
have hope. Depending on the severity
treatment can start with simple lifestyle
modification such as abstain from alcohol,
smoking and the use of recreational
drugs. Alcohol seems innocent enough
and I’m sure you all know people who
have children despite partaking in these
vices. However if you have an intention
to conceive and especially if you have
fertility issues my strong message would
be to stop altogether.
Diet is very important and a balanced diet
is one that is rich in fruits, vegetables,
protein with adequate amounts of fat and
starch. Good hydration is key with intake
of about 3 liters of fluid per day.
Exercise improves circulation hence
improving oxygenation of tissues. Well
oxygenated tissues perform much better
than poorly oxygenated tissues as can be
seen even in athletes and their various
gear that hopes at improving circulation.
In
mild
case
of
oligospermia,
asthenospermia, teratozoospermia or
oligoasthenoteratozoospermia (OATs),
lifestyle change can be effective. Some
companies advocate for use of supplements
but no large study has actually proved
that there is an actual benefit in their use.
I however do still prescribe them as they
do not harm and reduce oxidative stress
which improves tissue oxygenation. As
mentioned earlier well oxygenated tissues
perform better.
In slightly more severe forms where no
improvement from lifestyle modification
has been noted intrauterine insemination
(IUI) can be utilized. This involves getting
In order to get the female partner to conceive
the male partner must be able to produce
enough healthy sperm and the sperm should
be adequate in terms of number (quantity) and
function (quality). We measure this through
a semen count. For a good sperm sample we
actually need at least 39 million sperm in the
ejaculate. A crazy figure considering that phys-
iologically only one sperm should fertilize the
egg to produce a normal fetus.
a semen sample from the male partner,
preparing it to get a higher concentration
of motile sperm and then introducing the
sample directly into the woman’s womb
thus reducing the distance the sperm has
to travel to fertilize the egg.
This can be done in a natural cycle or in
a cycle with use of ovulation induction
agents. The tricky part is timing ovulation
perfectly and even that does not always
result in pregnancy. Success of IUI is very
limited and even in well-chosen clients the
success is only about 15% and this is after
6 cycles of IUI which roughly translates
to 6 months if someone was doing it every
consecutive month. Highest success is
achieved within the first, second and third
cycles with limited increase in later cycles
so a lot of people will not do more than 3
cycles before moving on to next form of
treatment.
With failure of IUI the next step is to
do In-Vitro- Fertilization (IVF) and
this helps couple with oligospermia. This
process will need a lot of sacrifice from
the female partner as the brunt of IVF
is born by her. The female partner will
be stimulated with injections to produce
multiple eggs. Eggs are then harvested
from her by a minor procedure usually day
case with a special needle.
Once eggs are collected they are mixed
with sperm in a special container to
facilitate fertilization of the eggs. The
resultant embryos are then placed in the
woman’s womb at an appropriate time
hoping for implantation and subsequent
growth of the fetus.
In severe case of oligospermia or OATS
and in cases of obstructive azoospermia
(OA) and in some lucky cases of Non
obstructive azoospermia (NOA); Intra-
cytoplasmic sperm injection (ICSI) can be
performed. ICSI entails a similar process
like IVF except the sperm is now directly
injected into the egg or oocyte ensuring
fertilization has occurred. This has been
one of the greatest advances to solve male
factor infertility as even sperm harvested
from testes which are not yet motile can
be used to fertilize the eggs.
Unfortunately not all couples will be able to
conceive using these assisted reproductive
techniques and a good number will be
due to the prohibitively high cost of such
treatment. Regardless of whether you have
a failed cycle or can’t afford say ICSI the
alternatives would be to use donor sperm
in either an IUI cycle or for IVF/ICSI.
For those who are still not successful or
don’t want to use the donor sperm then
adoption is the last resort.
With this I hope I have given an overview
of male infertility and more importantly
given hope to anyone who has been
silently struggling with this issue. Till
next time do have a Merry Christmas and
a Happy New Year.
Dr. Maureen Owiti is a practicing
Obstetrician Gynaecologist and fertility
consultant based in Nairobi. You can
commune with her on this or related
matters via email at: Drmaureenowiti@
gmail.com.