More men are infertile

50% of failed conceiving is due to a male factor but treatments target women

Kampala, Uganda | FLAVIA NASSAKA | Male infertility is the new social crisis, according to Carolyn Nakakande who heads a group of about 500 women trying but failing to conceive. They have formed a group called Blessed Be My Womb and their leader says; unfortunately, the crisis of male infertility is not getting the attention it should.

She says infertility is so highly misunderstood in the country that even when women who fail to conceive are tested and found to be alright, they never consider asking their husbands to go for checkup.

“Testimonies from bold women who have taken their spouses for checkup show they actually find it’s their men with a problem,” she said.

Dr. Tamale Sali, the medical director at the Women’s Hospital International and Fertility Center agrees with the women. The centre carried out the first In Vitro Fertilization (IVF) in the country and is among the leading providers of fertility services having conducted about 10,000 IVF procedures since they established in 2004. IVF is a procedure where a woman’s egg is fertilized outside her body.

According to Sali, results of the couples that report with infertility problems at his hospital show that 30% of the causes are from the man, 60% from the woman, and in 10% of the cases both partners have a problem.

He says, based on these results, his hospital resolved that before embarking on any kind of fertility treatment both a male and female have to be tested even if more women than men seek services at the center.

“The first thing we do is take history from the couple. The men may claim they have children but when we check them they don’t have a seed that makes babies,” he explains that the sperm analysis that is done after two days of abstinence takes about five minutes and is cheaper compared to other tests.

“It should always start with the man. If a couple is still unable to conceive within a year of marriage then there’s a problem. The mistake that many doctors make is exhaust all female tests but ignore the men,” he said.

Failure by a couple to conceive can be a frustrating experience and was the main topic during the International Infertility Symposium on March 01 in Kampala. The first of its kind to be held in Africa, the symposium was on the lookout for solutions.

Held under the theme; “Infertility awareness, Access, Capacity building and management in Sub-Saharan Africa for Happy families”, the symposium was partly to create awareness about the options available for struggling couples.

One of the issues that came up was how to enroll more men into fertility care. This was after Tina Buchholz, a Scientific Director at the Germany based Centre of Reproductive Genetics pointed out that even as World Health Organisation figures show 50% of infertility is a result of a male factor; the problem is almost never talked about as a man’s issue.

And this is what women in Uganda are currently grappling with.

“All doctors have said the same things. Uteruses, tubes, cycles, eggs I’ve heard it all, I’ve done it all,” said a 34 year-old woman who asked not to be named.

She told The Independent that she and her husband married six years ago but she has failed to conceive. She said they are now trapped in a medical mystery where doctors have tested one potential solution after another. She said she had undergone several rounds of unblocking tubes even as tests always revealed everything is okay. She had recently just abandoned herbal concoctions she had resorted to. Despite this frenzy, she said, her husband has never been tested.

Ministry of Health figures show that infertility affects about 15% of couples of reproductive age in Uganda. The figure could be bigger but is underreported. The figures appear to correlate with studies done in the West that show that sperm counts have declined by more than 50% in less than 40 years.

Sali says increased awareness could be a factor in the new results as more men are now having their fertility investigated. He says it’s only now that men are starting to realise that what they might have is a medical condition like any other. He says many men still do not know where to go to seek help and, since infertility does not cause physical pain or kill, “many tend to hold on to their problems”.

To him, only a few men suffer from congenital infertility like undescended testes, the majority up to 50% become infertile because of sexually transmitted infections whereas about 15% is due to viral infections like mumps whereas in some cases environmental factors such exposure to radiation and trauma caused by kicks or accidents are a reason.

Another Expert, Dr. James Olobo-Lalobo a Consultant Fertility Specialist says about 10 to 30% of men have fertility problems some arising from lifestyles like smoking, excessive alcohol consumption, overly tight pants and hot saunas which harm sperm production.

“We have testis outside our bodies for a reason,” he explains “they are supposed to be at least two degrees cooler than the rest of the body and once their temperature is risen it can have an effect on fertility”.

However, while doctors point out a number of issues that show need for men to get fertility services, their options for treatment still do not match that of women. Olobo says that could be down to women having functions of gestating and birthing that have made them the center for research. It could also be that male issues can be easily treated because they are easily examined for their reproductive organs are outside the body. He says their emission too can be easily got for analysis.

According to World Health Organisation, one in every four couples in developing countries has been found to be affected by infertility. This prevalence is based upon patient numbers who came to the clinics requesting for assistance related to infertility. Unfortunately in Uganda such treatment is largely offered in private health facilities and therefore attracts a cost which may not be affordable to the patients. And worse, most of the assisted reproductive technology clinics are located in the city and urban centers.