The recent report that in Nigeria, three in every 10 couples struggle to conceive, has again stirred another round of controversy.
This time, the argument has shifted from the usual belief that women are always responsible for infertility to the new finding that infertility among men is actually on the increase.
According to a private medical practitioner in Nsukka, Enugu State, Dr. Kenneth Ugwu, the thinking in the past that women were responsible for infertility in marriages was no longer tenable.
The table has turned and a greater percentage of infertility in marriages today, is attributable to male factors.
“In time past, it was generally believed that 60 percent of infertility is due to the female factor, while 40 percent is due to male factor, but recent study has shown a sharp increase in prevalence among men.
“Now, it is 60 percent male and 40 percent female as compared to those days.
“This is because the major causes of female infertility, like unsterile abortion that leads to infection and blocked tubes has been taken care of by the advancement in science and technology. And late female marriages have also gone down,” he told newsmen.
This was also confirmed by a survey conducted by the Medical Director of Good Tidings Hospital, Surulere, Lagos, Dr. Gabriel Akilo.
His survey on the prevalence of infertility among couples who presented themselves for checks in his facilities, confirmed that there has actually been a paradigm shift from what the case used to be.
“It is common in our environment that it may not even be the woman that is having problems; it may be the man, but you will find it difficult to convince men to go for the test because there is this belief that once the man can perform sexually, he is alright.
“There is a quote in Yoruba that men can never be barren, but by the time you subject the man to investigation, you will find out that the reason for the infertility is actually the male factor,” he told our correspondent.
Experts agree that why male factor infertility has refused to go down is because nobody can identify the cause of low sperm count, which is the commonest cause of male infertility.
Most low sperm count cases are referred to as idiopathic, meaning that the cause is unknown.
As the argument rages, Bridge Clinic, an assisted reproductive centre with a 25-year history of helping families, has warned that male infertility was becoming increasingly prevalent.
According to the Medical Director, Bridge Clinic, Toyin Ajayi, more men are struggling to produce potent sperm, partly due to poor diet, recreational drug use, and other environmental factors, reducing the chances of conception.
“We are finding out from a lot of couples coming in that male infertility is on the increase. Studies are going into this to find out more facts.
“Even for young men in their 20s, who voluntarily want to be sperm donors, what they find out when they do their parameter is very scary,” Ajayi told newsmen.
However, the Medical Director of The Healthcare Hospital, THH, Festac, Lagos, Dr. Chikodi Onyemkpa does not believe that fertility among men is rising.
He noted that what was happening was that people were making more inquiries, which were leading to the emergence of more facts.
“The more we get information, the more we are reassessing the platforms we are comfortably occupying.
“Previously, we thought this disease was not there, but as we began an inquiry, we found out that the disease is there.
“And as we make more enquiries, we find that the disease is more in place and we are now saying the disease is rising. No, the disease is not rising, rather people are making more inquiries and they are finding more facts,” he argued.
He noted that “why it used to be thought that it was women that had infertility in the past was because it is a man’s world, women are the ones that bear babies.
“So, when a woman cannot bear a baby, we say it is this woman that cannot bear a baby.
“We tend to disconnect from the mind the fact that this woman actually should have been impregnated by a man before she can bear a baby.
“So, we assume that since she has had a sexual relationship with a man, she should be pregnant and produce a baby.
“But, because modern science makes us look at the two parts of the equation, we are now seeing that if it takes two to tangle, why should we always be finding one person responsible or guilty?” He queried.
He also noted that because of the cultural assumption anchored on lack of scientific knowledge, every man on Nigerian street who has a penis that can get erect thinks that he can make a woman pregnant.
“So, when he sleeps with a woman, he believes that she should bear children,” he said.
“But the reality,” he continued, “is that it is not so; an erect penis is not synonymous with a fertile penis.
“That there has been an ejaculation does not mean that an ejaculum contains active sperm cells, but those assumptions were comfortably left in the domain of culture, implying that once a woman has been copulated with, she has a responsibility to produce a baby.
“It was on that premise that it was thought that men were generally fertile and that it was women that had problems.
“Now we are making more inquiries. Women will generally go to punish themselves because they are looking for babies. Now, doctors will tell the women that they want to see their husbands and check them.
“And some husbands were reluctant to come. Now, more husbands come because the women can speak more English, because there are social media now, and because generally, the culture is moving as education is improving, so we can make some interrogations now.
“Previously, the woman was accused of not being able to make babies and the whole family agreed, including the woman’s family, and they would find another woman for the man.
“I have seen on one or two occasions where you find a smart woman who finds out that the man has a problem and goes outside to get pregnant.
“And even when the man finds out, he will keep quiet because he knows that about two other women had been with him and left him.
“So, he will join everybody to thank God that the woman has proven that he is a man; meanwhile, the woman was only a smart woman.
“So, I don’t think that we can confidently say that infertility is rising among men. We should first establish a standard and from there, we can begin to benchmark what we call increase or decrease,” he submitted.
Why infertility among men
Dr. Onyemkpa’s argument is that infertility has always been with men just as with women but because of some factors like cultural orientation, women have always borne the brunt.
Much as believes that castration, viral and bacterial attack on the testicles were the common cause of infertility in men, he also stressed that there are a lot of conspiracy theories around male infertility.
He started with where the house of what will make a man fertile is located in the body, saying, “It is inside the testicles that dangle between a man’s legs and every male animal mostly has that. So, if anything happens to those balls, infertility has come; whether the thing happened to them physically or imperceptibly.”
On the place of castration, he noted that to make eunuchs, one has to go and remove those testicles by castration.
“Once you have removed it, you have removed the things that will make the man fertile,” he said.
He also stressed that “if that process happens in a way that one cannot perceive it, for instance, then, it means that germs have attacked the testicles and damaged them, even though they are still looking good and the man will be infertile because those balls are still there but they are now incompetent to render the service for which they were placed there.
“And there is a germ that naturally will easily do that free of charge. That germ is called mumps. There is this swelling that occurs around the salivary gland; it is caused by a virus called mumps virus. That same mumps can also affect the testicles and damage them.
“So, when a child is having mumps, some of us worry, not because they have mumps that is affecting their salivary glands, but because if that virus also attacks the testicles, the child will no longer be able to bear children when he grows into an adult,” he stated.
He also did not forget the role of bacteria, when he said: “If there is also an attack by an aggressive bacterium that goes to damage that factory that produces sperm cells, there will be infertility.
“That is why the people that operate roadside shops become experts in treating staphylococcus.
“If staphylococcus attacks the production centre and succeeds in creating an infection that causes enough trouble, the production of sperm cells will reduce and the person’s fertility might reduce.”
Dr. Onyemkpa also threw light on the role of the chemical agent that may be part of the food people eat, which he considers as a conspiracy theory.
“This is actually where the conspiracy theory has its fault that some of the foods you eat have become genetically modified to attack the ability of the body to produce the reproductive cells.
“And because of it, that is why one race wants to eliminate another through foods, vaccines and all that. So, you see why I said it is a cocktail of conspiracy theories.
“If they have their facts, I don’t know. Sometimes, there might be enough for you to suspect that some of those arguments might be correct or those the fingers are pointing at may not have done enough to dispel the rumours,” he further told newsmen.
He also stressed that age could be another factor that contributes to infertility in men, even though it is more on the side of women.
He said: “Let us also say that even for the male, as well as for the female, that as we get older, the ability to reproduce tends to begin to wane; that’s just the natural reality.
“However, it tends to be more obvious in females because the time of life for child bearing is cut-out.
“For the males, the time might extend longer but it does not imply that fertility does not drop as people get older. It is a natural rule.”
However, there is the common argument that some men cannot impregnate a woman because their sperm counts are too low and need to be boosted before they can get a woman pregnant.
Reacting to that, Dr. Onyemkpa drew an analogy with a production factory to explain the role of sperm count in getting a woman pregnant.
He said: “It is just similar to the logic of a production factory. Let us say that a factory producing soap is supposed to produce 10 cartons of soap every day and as long as it is doing that everybody is happy.
“What happens if the road leading to the factory is bad and the government has not reconstructed the road and the electric cables that supply light to the factory have been vandalised?
“It means that workers will be compelled to carry the materials on their heads to the factory and physically or manually do the mixing and carry what they produce to the road.
“If that happens, you will agree with me that they may not be able to produce two cartons of soap a day.
“If what we define as success is that they should be able to earn $10 a day and one carton is a dollar, and they have been producing 10 cartons when everything was optimal and now, things are no longer optimal and they can only make $2, you can also agree with me that they are no longer successful. And the fault is actually because the factory is no longer producing.
“So, now the testicle is the factory. The sperm cells are the 10 cartons of soap. If there are bacteria or viral attacks in the factory, the output will reduce; that reduction in output is equally the reduction in success.
“What now happens is that we try to interpret success with numbers. When we say that the sperm count is low, we are saying that the ability to produce results has been severely hampered.
“And you ask us: what do we do? We say we should raise the sperm count so that success can become possible again. We should reconstruct the road again and replace the vandalised cables.
“Reconstructing the road and replacing the vandalised cables are the tablets you are taking or the recommended food you are taking so that the factory can come alive again.
“Otherwise the factory doors are open but they are under-producing. Instead of 10 cartons of soap, sometimes, they manage to produce one carton and workers still demand their salaries because they are working but the output is not good.”
Solution
Speaking on how to deal with infertility in men, he noted that everyone is dealt with at the level where the problem is.
“That is why when people get to the hospital, they tell their stories, the doctor listens, asks many questions, does some examinations and add collaborative support so that he is able to find out the real issue at play in this particular instance of reduced fertility because all shoes are not of the same size, and so, there cannot be one size for all.
“If the problem has been, for instance, that mumps damaged the testicles when the person was a child, well the factory has been destroyed. It is not possible to make anything in that factory again.
“If there is an assault by some bacteria and we now begin to kill the bacteria so that whatever is left behind can continue production, hopefully, the numbers of the value of what they produce will rise and they will return to business again.
“So, one is that the market has been demolished, everything burnt and nothing can be sold there again. The other one is that they burgled the place but there are still some raw materials that are left, so we can start production again.
“So, what the doctor does is to find out what the exact situation is because what will be suggested for remedy will not exactly be the same,” he submitted.
