Alabi: Alcohol, Tight Underwear, Spending too Much Time in a Car are Risk Factors for Infertility in Men

Dr. Olajuwon Alabi is the Medical Director, Southshore Women and Children’s Hospital, Lagos. In this interview with Nume Ekeghe, he talked about risk factors associated with infertility, the myths, and available solutions to the condition
Can you speak more on your specialties in Southshore? 
In Southshore, our services covers obstetrics, pregnancy related gynecology issue, and then we look after pediatrics as well. One of the reasons Southshore was set up was because of the standard. We want to be able to offer services that would reduce the number of Nigerians that travel abroad for specialised procedures and surgeries and unfortunately, there is still a skill issue in Nigeria. So that was idea in starting up this place.
From gynecology which is one of the major part of our work load is fibroid. We are one of the leading players in terms of managing fibroid because we can offer almost all options in safe environment. We have done thousands of surgeries in the last five to six years and I’m happy to say that there has been no mortality. What that means is that you don’t necessarily have to open people to have surgeries. We do minimal invasive surgeries which is also called keyhole surgeries allowing people go home almost the same day or the next day with minimum bleeding. Unfortunately for us in Nigeria, we don’t have many centres capable of this, unlike if you go to the advanced countries where a lot of people are offering it.
Is minimal invasive surgery common in Nigeria?
The skill is currently developing in Nigeria and we hope to be able to in a few years train a lot of Nigerians to be able to do. I am part of the society of gynecology endoscopy where we are hoping to increase awareness and training for Nigerian gynecologist to be able to offer this kind of procedures and we are having our first conference in September this year.
What are your success rates for minimal invasive surgeries?
Success rates can be defined in different levels. The first level is how successful was the surgery, that is if the person survived. In terms of that, we have a 100 per cent success rate. Now the other success rate is if the surgery worked. However, that is quite difficult to measure because a lot of our patients come from different part of the country and some cases out of the country. Recently, we had people come in from the United Kingdom to do surgeries here because of their long waiting list. In terms of how many people get pregnant after they have surgeries here it is difficult to do. But I can tell you that we are happy that when a lot of centres refer patients to us, the comments we get back is that it seems as if there is something we do that makes the IVF to work.
I remember when we started Southshore most patients were referred to South Africa to do surgeries that is retiringly available now.
When should couples access IVF?
I think sometimes when couples are experiencing infertility, they run to Invitro Fertilisation (IVF) centres. However fertility is divided into three main parts, namely primary, secondary and tertiary. Tertiary means you have tried everything else and it hasn’t worked then you are now going for IVF because there are a lot of other things you can do to get people pregnant before getting to IVF. That still takes me back to the minimally invasive surgery that can be used to correct tube abnormalities. Also, some people who have scar tissue inside their wombs, something called Asherman syndrome where what we need to do is use a camera to go in and clean up the inside of the womb particularly in women who have not had their periods in a long time or have reduced which is based on an injury that has happened previously. We also have gynecology cancer specialist that deal with gynecologic cancer.
Is there a specific time frame before a couple can seek help?
A couple that have no medical history and is newly married we would say should try conceiving one to two years. As long as they have regular intercourse and by that I mean two or three times a week.
So also when investigation is delayed, sometimes can also be a challenge because in some cases the woman may have fibroid or a condition called endometriosis or a pregnancy termination and that increases the risk of a person to have fertility issue. So the first thing is that there must be an assessment in the beginning.
I think unfortunately there is a lot of pressure on the women in our country. So everything is streamlined and once you finish university, you are expected to get married, then your mother in-law would start to ask questions. So there is a lot of pressure on women. People should enjoy their marriage and acknowledge that God gives children and at the right time, God would give children rather than putting so much pressure on oneself.
There are people who have been married for 10 years without children and on the tenth year, it seems like a tap was opened and then pregnancies start happening. For them, that is their timeline but unfortunately, the society puts too much pressure here.
However, fertility treatments are not cheap, they are expensive but if a couple plans well it gives them the opportunity to start embarking on fertility treatments. In my view, the best thing is to ensure that couples have tried enough.
There is a stigma that goes with infertility and women usually take the blame. How can this perception change?
The first thing is to create awareness that fertility is not a woman’s issue. Fifty per cent of the cause is from men. Unfortunately, a lot of men are still egoistic about it and tend to not believe they can be at fault. Infertility is not for a single person, it is something that happens in a couple. However, some people come in and they immediately say ‘my husband is fine’ and I don’t think that is the right attitude. I usually like speaking to couples and then letting them understand the issue which comes from information really. We need to investigate without being aggressive and we start off with knowing you are fine but let us just confirm it. Sometimes as men, we want to believe we are right all the time so somebody needs to let them know that there is a small possibility that there might be a problem. However once there is problem, we always let people know that there is a solution.
What are the major causes of infertility in men?
One of the major issues particularly in this part of the world, is that men drink a lot of alcohol. So alcohol is a risk factor and also spending a lot of time in the car because what happens especially if you are driving a car that generates heat. This goes towards the scrotum area and that can reduce sperm count. Also we live in a warm environment and a lot of people wear tight clothes surrounding their organs and that also reduces the sperm count.
The take home message is live safe, drink a lot of water, no smoking, and no drinking. Also, when you are at home, and you aren’t obligated to cover yourself, maybe take your underwear off so air can circulate. Watch what you eat as well, obesity is a contributory factor both for men and for female as well.
There is a research where what they did was ensure sperm was exposed to cigarette and they can see the sperm die off. So it is natural that when we see couples, we inquire if any of them smokes and advise they don’t. So lifestyle modification is very important. Do a lot of exercise, eat healthy, drink a lot of water and be careful of what you wear, as well particularly men.
What advice do you have for married couples who have been trying for years and don’t know where to start from?
The first thing is that they should enjoy their marriage and don’t let the pressure of the society weigh them down. Seek help as well. Look for good hospitals and ask a lot of questions. When you go to a hospital and they want to plan a procedure and you are not happy with it, seek a second or a third opinion and if everyone is singing the same tune it is likely that the information given is correct. But if there are different tunes then just get more experienced opinion before you make a decision.
Also, there are so many IVF centres and some are good but I would also advise people not to rush into IVF. They should make sure they have a good gynecologist that can explore the reason why there is a problem and if there is no problem.
Also there are other options like adoption. There are so many children out there and it has also been proven that sometimes, stress has a significant effect on people when it comes to fertility. So in adopting a child, that reduces stress and your focus a bit and I have seen people conceive after they had adopted a child or children.
Also, things like surrogacy should be explored for people that have damaged wombs and cannot get pregnant themselves other people can help them carry their pregnancies. Genetically it’s their baby. But they are just using someone else to carry the baby. So there are so many options opened to Nigerians at the moment.