Declining sperm counts: Expert advises on causal factors, solutions

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By Francis Ugwu

Recently, male infertility has become a big worry to many health practitioners.

Research findings have shown that more men are suffering from infertility than ever, a development described by a fertility scientist, Dr Shanna Swan, as a “global existential crisis.”

Swan warned: “The current state of reproductive affairs couldn’t continue much longer without threatening human survival.”

According to the US Population Reference Bureau’s 2021 Data Sheet, fertility is down in many nations, including low, middle and high-income countries.

The World Health Organization, WHO, also recognised the decline in counts and quality of spermatozoa, which gave rise to its revision of the criteria for normal versus abnormal sperm counts to be used by andrology laboratories worldwide. While normal sperm count ranges from 15 million sperm per millilitre to 200 million per millilitre, WHO deems a rate below 15 million as “low.”

A Stanford University study further indicated that infertile men die younger than their fertile peers. The other implication is that men with sperm concentration lower than 15 million per millilitre had a 50 per cent greater chance of being hospitalised for any medical reason at all, and poor fertility has been linked with higher rates of diabetes, heart disease and cancers.

Several causes and risk factors have been speculated and, in some instances, proven for male infertility. These are published in medical journals. The common causes and risk factors include smoking, alcohol intake, drugs, obesity, past or present testicular infections, exposure to environmental toxins, exposure of the testicles to excessive heat, hormonal disorders, testicular trauma and ejaculatory/erectile disorders, among others.

A study by a group of scientists from Nigerian universities further grouped the cause/risks into broad categories of physiological or biological, behavioural or lifestyle, environmental, and socio-demographic factors.

Despite the evidence of declining sperm counts worldwide there has been limited public enlightenment about causal factors for male infertility.

Dr Ajayi Abayomi, the Medical Director of Nordica Fertility Clinic, Abuja, spoke exclusively with DAILY POST and provided more insight into the male infertility conundrum. He emphatically debunked the popular myth surrounding couple’s infertility, when he avowed that “men are responsible for about 60% of the causes of infertility.”

With the benefit of his knowledge of the subject and his training and skills at having handled many such cases, Dr Abayomi provided concise and comprehensive enlightenment on what every man should know about male infertility. Excerpts:

Declining sperm count in Nigeria

A study about two years ago in America and Europe said that sperm count has reduced in the last forty years by 50%.

We also conducted research in our clinics in Lagos, Abuja and Asaba. We looked at the sperm parameters of men who presented themselves in our clinics, and we saw a 30% decline in the sperm of men who showed up in our clinics in Nigeria.

Though a clinic-based study, unfortunately, it also bears credence to what is reported in Europe and America. It might be fair to say that sperm count globally might be reducing.

Causes of male infertility

One can look at so many factors, but probably one of the elephants in the room is lifestyle. We know that obesity and sperm count do not go together; we know a lot of young men are taking hard drugs these days for different reasons. Some use it for recreational purposes, as aphrodisiacs and for weight lifting. Some use these steroids to gain six packs. All these can affect sperm count.

Diagnosis of infertility

Infertility is the inability of a couple to conceive or have a live baby after twelve months.

We have also done it in a way that it is now age-related. We say twelve months, if the woman is below 35 and six months, especially if she is 37 and above. So when the cause is either solely or being contributed to by the man, we call it male infertility. You can say infertility is the inability of a man to get his female partner pregnant.

Unfortunately, most cases of male infertility don’t have symptoms for the man to have a clue that there’s a problem because he can do almost everything. He can have sex. He can ejaculate most of the time; the problem is that his spermatozoa might not just be strong enough to get the job done.

The only test that can tell whether a man can impregnate his wife or not is seminal fluid analysis, which is the examination of sperm cells under a microscope.

In this, we look at parameters. We look at the volume of the sperm. We look at the count of the sperm. We look at its ability to move. We look at the morphology, and then we also look at the presence of white blood cells.

The World Health Organisation, WHO, has fixed values for all these for us to know if the sperm count is normal or abnormal.

Treatments for male infertility

The proven most effective method for treating male infertility is the procedure we call Intracytoplasmic Sperm Injection (ICSI), which involves injecting one sperm into one egg, and that is done under the microscope.

When you fertilised the egg, you transfer the fertilised embryo into the woman. The transfer can be done on days two, three or five. The result of ICSI is as good as that of IVF.

There is also another procedure called Intracytoplasmic Morphologically Selected Sperm Injection, IMSSI. As the name suggests, by “morphologically selected,” we look for the normally formed sperm to inject into the egg.

We later found out that some of these patients that got pregnant still had a miscarriage because the sperm was not great.

Consequently, we started looking for other methods by which we can screen sperm because, with ICSI, the results are based on the quality of the sperm and the quality of the egg. So you must have the method that can give you the best sperm no matter how bad the surrounding is.

We started doing Physiological Intracytoplasmic Sperm Injection, PICSI. In PICSI, we looked at why it is that when millions of sperm surround the egg, it’s only one that can enter. We started looking at the quality of sperm that could enter. We saw that it has a specific enzyme richer than other sperms, and that’s why it was able to enter. That’s why we called them Physiological ICSI.

The last treatment procedure for male infertility is DNA fragmentation. The only thing the sperm contributes to the equation is the DNA at the sperm’s head. The man and woman exchange DNA at fertilisation to form a new life.

If the man’s DNA has been denatured or broken down more than normal, the embryo you might get might not be top quality and unable to form a baby. We have now devised a means to test the sperm to see how much denaturation of the DNA has taken place. That would be a direct reflection to see how it is for sperm to be able to fertilise the egg and develop from the stage of fertilisation to stage five of the trimester probably.

Genetics, nutrition and male infertility

There is a kind of infertility that you can inherit. While we cannot reverse the way we are created, some human advancements, such as gene editing, can correct certain conditions in the body.

Nutrition, also, affects the quality of sperm because nutrition is part of lifestyle.

We are made of what we eat ultimately. If you eat things that will predispose you to diabetes, you should know that diabetes further reduces your chances of having a baby and even a man being able to impregnate a woman.

To stay fertile as a man, you need to eat healthily and stay healthy. The rules are the same, avoid refined carbohydrates, take more plant-based protein, and avoid saturated fats and alcohol. That’s why I said it is about lifestyle choices because alcohol is not food. Alcohol is a big factor; cigarette smoking is a big factor; drug is a big factor.

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