Male infertility is defined as the inability of a male to make a fertile female pregnant, for a minimum of at least one year of regular unprotected intercourse.
Historically, when a couple cannot conceive, the woman carries the stigma of infertility. However, men and women are just as likely to contribute to the couple’s infertility.
A study conducted by Ashok Agarwal and colleagues from Cleveland Clinic in the United States (US) revealed that at least 30 million men worldwide are infertile, with the highest rates found in Africa and Eastern Europe.
Many couples struggling with infertility turn to the internet for infertility-related content and to connect with others going through similar experiences, but most of the published data on infertility only addresses the experiences of women, with limited studies focusing exclusively on the internet discussion on male infertility.
Male infertility is associated with poorer overall health, increased cancer risk and decreased life expectancy. Strategies of providing for surrogate fatherhood, whether secret boyfriends or arrangements to bear children with a brother-in-law, have historically been considered as protective of men who are infertile in Southern Africa.
There are multiple causes of male infertility. It is sometimes not possible to define the cause, but infertility may be caused by hormonal imbalances (estimated at 2 to 5 percent), or sperm transport disorders (such as vasectomy) (estimated at 5 percent).
Lauren Wise and her colleagues from Slone Epidemiology Centre, Boston University in the US, reported that cycling for more than five hours a week is associated with low sperm concentration.
It is notable that, in rural Malawi, there has been an increase in the use of bicycle taxis as a means of transportation in recent years.
Wakisa Kipandula and others from the Department of Medical Laboratory Sciences at Kamuzu University of Health Sciences (Kuhes) conducted a study to evaluate the semen profiles of bicycle taxi cyclists in Mangochi District and found that bicycle taxi operators had lower semen volume, concentration, total motility and progressive motility as well as a higher concentration of abnormally shaped sperm cells.
Primary testicular defects (which include abnormal sperm parameters without any identifiable cause), are a major cause of infertility, estimated at 65 to 80 percent.
Idiopathic infertility (where an infertile male has normal sperm and semen parameters) makes up about 10 to 20 percent of cases.
Malawi’s National Policy on Infertility recognises that infertility is a condition that can often be prevented, if the causes are detected early and reproductive tract infections are managed.
The work of Associate Professor Fanuel Lampiao from Kuhes showed that, in Malawi, there is no recourse to assisted reproductive technologies designed to overcome male infertility problems.
Indigenous healers in Malawi, as in other parts of sub-Saharan Africa, tend to treat childless men for problems of sexual virility, which further humiliates men by confusing infertility with impotence.
Analysis of semen is the cornerstone of laboratory evaluation of male infertility. At least two samples are collected, separated by at least one week and preceded by at least three days of sexual abstinence.
Semen can be collected by self-gratification or using special condoms for collection which do not contain any toxic substances.
The specimen should ideally be collected at the laboratory but can be collected at home if it is kept at room temperature and rushed to the laboratory, as it is critical that the sample is examined within an hour of collection.
The four categories of sperm defects that lead to a diagnosis of male infertility are low sperm count, poor sperm motility, defects of sperm morphology (abnormally shaped sperm) and absence of sperm in the ejaculate.
Some infertile couples still manage to produce a pregnancy. Studies have shown that 23 percent of untreated infertile couples conceive after two years, increasing to 33 percent after four years.
Reasonable healthy lifestyle changes are recommended. These changes included stopping smoking, limiting or eliminating alcohol intake, adopting a more nutritious diet, weight loss and increased physical exercise.
Low body weight is also a possible risk factor for male infertility. Fish oil supplements have been suggested as helpful in improving male fertility.
Simple treatment options for men with proven male factor infertility are limited to cases requiring ejaculatory duct resection, vasectomy reversal or varicocele repair.
Antioxidant therapy has demonstrated some beneficial effects on sperm quality and male infertility. A study conducted by researchers from Cape Peninsula University of Technology in South Africa revealed that drinking Rooibos tea can potentially improve semen quality.
Further work is needed to confirm the value of antioxidant therapy as well as the optimal ingredients and doses.
Elias Chipofya is a medical laboratory scientist