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

DRUM - - Health -

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.”


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

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