The epidemic of male infertility: Key actions to consider

By Sande E Oundo

When people talk about infertility or the couple goes to a doctor the usual suspect is often the woman and the man probably receives no empathy or care, however, due to multiple factors infertility in men is becoming more frequent. It’s coupled with stigma and negative implications for men in society if that isn’t enough, it is often expensive to get treatment for it even though it can often fail. 

The World Health Organization defines infertility as follows: Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (and there is no other reason, such as breastfeeding or postpartum amenorrhea or lack of menstruation). 

Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy. 

Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts. In 10–20% of cases, no cause is found. The male infertility crisis has been on the increase since the mid-1970s; sperm counts declined by 52.4 per cent between 1973 and 2011. It has impacted some regions more than others like Japan, South Korea, Italy, Sweden and many countries in the northern hemisphere which are facing a population collapse. 

Infertility has dire consequences on families, especially men in case they are solely responsible for it, including depression, addiction, weight gain, social stigma with isolation, marital fights, infidelity and even divorces, these issues can lead the man not to look for help.

Male infertility is commonly due to deficiencies in the semen count (ideally of 16 million sperm per millilitre), and semen quality like the shape and the ability to swim forward. Different factors have been blamed for it however historically male infertility was not diagnosed or investigated due to the social belief that all infertility is due to the women. 

Varicocele is a condition in which there is an enlargement of the blood vessels in the testicles which leads to abnormal sperms or no sperms at all. It is the cause of infertility for 40% of male infertility. Thankfully it is reversible with surgery and has a high rate of regained fertility especially if done early. 

Smoking Tobacco has been proven to cause infertility. Tobacco damages testicles kills sperms, prevents the production of sperms and can even predispose to varicocele. 

Genetical conditions mainly Klinefelter syndrome, where boys and men are born with an extra X chromosome that’s XXY instead of XY, and often found in 1 out of 500 men and is one of the leading causes of permanent infertility due to the lack of sperm production from the testicles, the condition is 

common with the children whose fathers are older than 35 years, age leads to deformed sperms and reduces fertility in men. Another condition is Y chromosome deletion whereby man has no Y chromosome at all. 

Other causes include erectile dysfunction (difficulty getting and keeping an erection), taking chemicals to gain muscles(steroids), some medications like antidepressants and antiulcer, abnormalities in male genital organs like undescended testes, infections like mumps and malaria, trauma to the testes and testicular cancer have all been linked with male infertility. 

Environmental factors like Phthalates which are found in plastics have been shown to predispose to abnormal formation of the male genitals in babies, anogenital distance is reduced with those babies also those boys display a preference for girl toys. Also, estrogen-like chemicals which are found in a lot of female cosmetic products like creams and perfumes also lead to

abnormal formation of the male genitals in babies. Other chemicals which have been linked are pesticides, substances found in receipts and cans which all impact hormones in men, rather temporarily. 

Lastly, heat can lead to the death of sperms and abnormally shaped sperms, that is why the testicles are outside the body because of the lower temperature needed for its production. So things which lead to overheating of testicles can predispose to infertility. 

Often the cause of infertility may be due to both the male and the female which would require caring for both through procedures like using the sperm for intrauterine insemination (IUI) which is releasing healthy sperm in the uterus with a device, or in vitro fertilization (IVF) which is extracting the sperm and the egg and fertilizing in a glass after taking hormonal injections to boost sperm production, or IVF with intracytoplasmic sperm injection (ICSI) which is the injection of sperm directly to the egg.

Unfortunately, most of these procedures don’t guarantee 100% success with varying degrees due to factors like age, the severity of the cause and the technique of the procedure resulting in multiple trials before success. They often come with a lot of stress, stigma and expenses which can range from 14.5M UGX to 36M UGX. 

Basically, As a man, there are a couple of things you can do to avoid infertility: The following have been highlighted as key actions/solutions and as such if well embraced the fight against male infertility can be won. 

1. Avoid smoking, excess alcohol and drugs like marijuana.
2. Losing weight, since obesity is linked with infertility. 
3. Not taking chemicals like protein shakes and testosterone to gain weight. 
4. Avoiding activities which lead to overheating of the testes like putting on fit boxers, driving for too long, putting your laptop on your lap, and frequenting saunas or hot tubs.
5. Not meddling in Pornography and vigorous masturbation can both lead to erectile dysfunction.
6. Avoiding skincare and cosmetic products which contain harmful substances. 
7. Taking a genetic or hormonal screening to rule out genetic conditions like Klinefelter’s syndrome.
8. Taking vitamin E and zinc which is found in foods such as barley, beans, and red meat at the same time avoiding processed food and soda. Zinc levels are highly associated with increased sperm volume/count and also help to protect sperm from damaging effects caused by toxins. 
9. Preferably having children before the age of 35. 
10. Wearing a protective guard over the perineal area in case of playing dangerous sports which can cause trauma to the testes. 

In a nutshell, male infertility has significant negative social impacts on the lives of individual males, marriages and societies at large manifesting with violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. Thus male infertility is a global population health concern which calls for public health education, awareness and sensitisation alongside practising a holistic lifestyle while living a meaningful, productive and long life. 

Sande Elison Oundo is a holistic health practitioner and President of Vigilant Living, A counselling and coaching company based in Kampala