Getting Pregnant: The Male Factor

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By Dr. Goke Akinrogunde

One clear thing is that getting pregnant is a case of “it takes two to tango”. The tango dance is a once popular native Central American dance that is danced close up by a male and a female companion.

As such, getting pregnant requires a reproductive healthy male and female. My concern today is about the reproductive health of the male partner.

An effective reproductive functioning in the male presupposes the ability to be able to manufacture an adequate amount of healthy and effective sperm cells in the testes and an enduring ability to effectively deposit the semen into the reproductive tract of a woman during sexual intercourse.

On the first part, only about 10% of the ejaculate during the climax of man’s sexual activity is made up of sperm cells (spermatozoa); the rest 90% is made up of the alkaline fluid, which contain nourishment for the sperm cells and also provide a medium for the fast moving spermatozoa (sperm cells) to swim towards fertilising the egg in the female’s reproductive tract.

Sperm cells are produced in the two testes while other organs like the seminal vesicle and the prostate contribute to the watery component of the semen.

From the foregoing, any development that will lead to an inadequate production of good quality sperm cells will invariably results in infertility or subfertility.

Similarly, inability to effectively deposit the pre-formed semen into the woman vaginal canal, as it is the case in the ‘impotence’, will also be considered as a factor in male infertility to say the obvious.

In the same vein, the testes located inside the scrotum require an appropriate temperature that is a little lower than the core body temperature for effective production of spermatozoa in adequate amount. Hence, it is known that in men who have a history of non-descent of the testes into the scrotum by the age of two, the tendency to developed male infertility later in adult life is very high.

Contrary to the wide belief, however, the effect that a tight-fitting pant will have on sperm production (spermatogenesis) in man is almost inconsequential, since this has been proven not to lead to any significant rise in temperature inside the scrotum.

Congenital problems
Usually, testes descend from the abdominal cavity into the scrotum just before birth in a normal termed baby. But in some very rare cases the testes never developed or descend at all! Un-descended testes will not be able to produce spermatozoa. These are examples of congenital factors, that is, problems that developed with conception and during pregnancy. There are others e.g. chromosomal problems like Klinifelter’s (XXY) syndrome and Supermale syndrome (XYY); however, elaboration on these not so common cases is beyond the intended purview of today’s publication.

Sexually transmitted Infection
Another common cause of infertility in male is a past history of sexually transmitted infection (STI) with gonococcus and Chlamydia, among others. These can lead to painful ejaculation and blockage of the tubes through which the semen transverses from the storage place, at the head of the testis called the epididymis,en-route the connecting tube, called the vas deferens, to the urethra i.e. the tube inside the penis, through which the semen, and also urine, eventually passes to the exterior. Consequently, these conditions can cause very low sperm count (oligospermia) or no sperm cell in the ejaculated fluid (azoospermia) due to the blockages.

Fortunately, some cases, certainly not all, of low sperm count that is due to previous STI are known to respond to medication, after appropriate semen culture and sensitivity tests have been carried out. Others may have to make do with the now available advanced assisted reproductive technologies.

Hormonal Imbalance
Another factor that can lead to low sperm count is unbalanced hormonal interplay in the production of sperm cells and their nourishment. Hormones – particularly FSH, LH and Testosterone – play important and complex interdependent roles in the production and maintenance of the spermatozoa. Such that an unbalanced production in any of these hormones might invariably lead to low production and guarantee less survival of the sperm cells.

Surgical Problems
Serious past surgical condition such as Torsion of the testis can also compromised the integrity of the testis in future, leading to inadequate sperm production and childlessness. Torsion as the names implies is a condition, not uncommon, where the testis is twisted on itself causing an excruciating abdominal and testicular pain that is sudden in onset and could be quite distressing. It requires immediate medical intervention via surgical operation to save the situation especially the ability to procreate in future.

Problem with the sperm cells
Structural abnormalities in the sperm cells are also important determinant in male infertility. The normal structure of a sperm cell is made up of an ovoid head, which contain the genetic materials, a body and long propelling tail that assists with its unprecedented fast track movement. Interesting to note here is that the sperm cell is the fastest living object known to man. A very important investigation to assess male infertility is the sperm analysis/count.

Semen Analysis
Usually, sexual abstinence is advised three or more days to the day of sperm collection for analysis.
*Normal sperm count should be greater than 20millon per milliliters.
*Volume must be up to 2.75ml per ejaculation.
*More than 50 per cent must be motile.
*More than 50 per cent must have normal form.

It should be mentioned that abnormal sperm count analysis in the first instance is not enough reason to sentence the concern to a diagnosis of male infertility, without another repeat and if necessary a second repeat of the semen analysis.

Various corrective approaches to overcome sperm counts related problems are available and offered readily at the fertility centers and other not-so-specialised centers in the country.

Artificial Intrauterine Insemination
This involves the artificial collection of semen which is then directly introduced into the partner’s womb, thus improving the chances of the sperm making it to the egg, after having by-passed the hostile vaginal environment, where most of the sperm cells usually perished. This procedure readily overcomes the disadvantaged situation in men that have low sperm count. In azoospermic husbands i.e. those having zero sperm count, a donor, who is usually unknown to the couple, can donate the sperm.

Intracytoplasmic Injection (ICSI)
Another very effective procedure that compensates for low sperm count in men is the advanced form of In-vitro fertilization (IVF), called Intracytoplasmic Injection (ICSI). This procedure, which is now readily available in some fertility centers in Nigeria, involves the harvesting of egg (ovum) from the woman, collection of semen from the man and the injection of a sperm cell into the ovum, thus achieving fertilization outside the body with the subsequent introduction of the resulting embryo into the womb for implantation and pregnancy to occur.

ICSI is a giant step in the management of male infertility; it has reduced the language of low sperm count to a meaningless phrase in fertility medicine. For desiring couples, it is available for those who can afford the ‘high cost’ of treatment, which runs into multiple hundreds of thousand in Naira.

Microsurgeries
I should also add that numerous microsurgical procedures are also available in some good centers within and outside country, where male with redeemable infertility benefits immensely from.

This may involve surgical repair of blocked tubes in male reproductive tract that areknown to be responsible for some cases of azoospermia and oligospermia, possibly resulting from a past sexually transmitted disease. Similarly, direct microscopic guided sperm aspiration from the storage point in the epididymis with subsequent intrauterine insemination can also overcome some cases of infertility due to no sperm cell seen in semen, which is due blocked tubes in those men.