THE NO-BABY BLUES
Infertility is as often a male problem as a female one. In the second part of our story we look at the reasons behind male infertility and the treatments available
EVERY month Lungile* and his wife Thandi* hoped this would be the month. But after three years of trying to have a baby and dealing with the monthly disappointment, they decided to go for tests. The results came as a shock to the couple, but especially to Lungile – he had a low sperm count, and there were also problems with the sperm’s shape and movement. Thirty-year-old Thandi’s tests came back normal.
“It was something I never thought about,” Lungile (32) admits. “I never thought it could have anything to do with me. I felt so bad. Luckily Thandi was amazing, but it wasn’t something I could discuss with anyone else. I thought my friends and even my family would look at me differently – like I wasn’t a real man.”
The tests suggested the best treatment option would be to inject a single sperm directly into one of Thandi’s mature eggs. This is called intracytoplasmic sperm injection (ICSI, see treatment options below). The couple conceived after five attempts, and after a healthy pregnancy their twin boys were born.
“It feels so good to see their faces every day,” he says. “I know my infertility problem wasn’t something I had control over, but it’s taken me a while to come to terms with it. I did tell my family eventually but I still have trouble sharing my story. Even though we are lucky and now have children, it’s not something I want everyone to know about.”
LUNGILE’S reluctance to talk about his infertility reflects the psychological pressure men feel when they discover they’re the cause of the fertility problem. Harvard Medical School studies show men experience the same levels of low self-esteem and depression as infertile women – but only when they are the ones who are infertile. And in Africa there’s the added element of stigma.
“In African culture having children is very important, especially for the male partner,” says Dr Saleema Nosarka, a reproductive medicine specialist, obstetrician and gynaecologist at Tygerberg Hospital. “Childbearing is a sign of wealth, manhood and strength, both in his clan and in the community as a whole.”
Although the exact nature of the link between stress and infertility is unclear, it’s fair to say stress is an issue for both parties.
For a start, evidence suggests a stressed couple is less likely to have sex and stressed people are more likely to engage in bad habits that affect their health, such as smoking and drinking too much.
“In men, stress can cause erectile dysfunction,” Nosarka adds. “If the stress is severe enough to impact on quality of life, it’s a good idea to consult a psychologist who specialises in this field.”
THE CAUSES OF MALE INFERTILITY
Male infertility is mostly about sperm – around 75% of cases of male infertility are due to there not being enough sperm or because the sperm are misshapen or don’t move as they should. Around 20 to 500 million sperm are ejaculated during an orgasm but only a few thousand make it through the fallopian tube to fertilise an egg. Anything that interferes with this process – a low sperm count or their inability to move – significantly reduces the chances of becoming pregnant.
The most common conditions that lead to male problems are: Genetics – when a man is born with problems that affect his sperm Illnesses such as mumps or scarring from sexually transmitted diseases Varicoceles, a condition that results in enlarged veins on the testicles Injuries, such as a sports injury Lifestyle choices like substance abuse or using anabolic steroids Certain medication, including treatment with chemotherapy or radiation therapy Environmental toxins, for example exposure to pesticides and lead.
A semen analysis is step one. A man may not have any noticeable symptoms, so it’s difficult to tell if there’s a problem without getting tested. Your doctor will do a sperm analysis to look at the number and shape of sperm and its ability to move, as well as to check for infections.
“Sometimes men are unable to produce a sample due to anxiety and stress,” Nosarka says. “But there is medication that can be prescribed to help with this.”
A sperm analysis costs between R300-R500.
The next step will depend on these results but may include the following:
Artificial insemination The man supplies a sperm sample, which is prepared in a laboratory and then inserted into the woman’s uterus (as explained in The no-baby blues, part 1, 14 September).
“The benefit of this option is that sperm
are washed and all the proteins, viruses and unhealthy sperm are removed from the sample,” Nosarka says. “This means only viable sperm are used.” Costs vary from around R1 500
R2 000. Intracytoplasmic sperm injection (ICSI) is a specialised form of in vitro fertilisation (IVF) that involves the injection of a single sperm directly into a mature egg. “It’s used when the shape of the sperm is very abnormal,” Nosarka explains. “A normal-looking sperm is chosen from the sample and is injected directly into the egg in a lab to help fertilisation.” ICSI will set you back around R10 000 in a state hospital. Physiological intracytoplasmic sperm injection (PICSI) is an alternative to ICSI and has an extra step to help select the very best sperm. It’s used when a sperm defect is suspected and sperm count is very low, and costs around R26 000 in private clinics.
Testicular biopsy This is performed for men with azoospermia – when there are no live sperm in the semen they ejaculate – or for men who’ve had a vasectomy (surgical sterilisation).
It’s a minor operation performed under anaesthetic where the surgeon tries to take out sperm from the testes. If successful, the sperm is injected into an egg in a lab as above.
A testicular biopsy costs around R3 500-R4 000. * Not their real names