Men contribute significantly to infertility - Ajayi
The issue of infertility remains a major issue in most communities in Nigeria with the woman taking the full brunt of it. In this interview, Dr. Abayomi Ajayi of Nordica Fertility Centre, throws light on male infertility, the place of IVF and how it can be made affordable so that hundreds of couples seeking for children of their own can benefit. He spoke with CHUKS NZEH. Excerpts:
How do we break the myth surrounding male infertility which says that men can’t be infertile, that infertility is a thing of the women alone?
Well, I agree it’s a myth, but I agree it’s already been broken because about 20 or 25 years ago, I saw a man hold up to a doctor’s collar and said “You said I’m not fertile.” So like you said, it is believed that infertility is a woman’s problem, but I believe that the populace are now getting aware that men can also have problems, and we know scientifically that men contribute equally to infertility with women, but the figures we are even seeing now shows that men might even be contributing more to infertility than women, and we did a recent study in my centre and we saw that about 12 percent of men that come for fertility screening don’t have sperm at all, not that they have low sperm count.
So we did another in which we compared sperm count in 2003 to sperm count in 2013, and we saw that there was a drop of about 30 percent.
Why we can’t shout about it is that these are not community-based studies, so there will be some screw because it is people that come to the fertility clinic that we are looking at. So we cannot say that that’s what obtains in the society, so what we are saying is that that is not only in Nigeria, it’s a global picture that male infertility is becoming more rampant. There was an article that somebody wrote and said that men might soon become extinct if care is not taken because sperm count seems to be dropping. So it’s not a Nigerian thing, it’s a global affair, but there is no doubt that men are contributing significantly to infertility in marriages.
What is responsible for the drop in male fertility?
If we knew that, we would have been able to reverse it. But there is no singular factor but so many factors have been incriminated. Initially, there was a belief that the problem starts from when the boy is in the mother, but now everything has shifted to saying that it is the environment that causes it.
There is now more environmental factor than being born with infertility, and some of the products that they incriminated are even some of the ones that you can’t do without such as toothpaste.
So, so many things have been looked at that could contribute to male infertility. Of course, there are studies that shown that men who work in where they sell petrol, that’s gas station, over a prolonged period of time.
So, your vocation is one thing that might also be incriminated. Some say that even the global warming stuff might be responsible, but the truth about it is that we cannot pin-point one particular thing, but the thing that we are saying is these are factors that seem to be in our control, which are the lifestyle factors, and that’s why now, we are talking a lot about lifestyle because that’s within our control. You can control your weight as much as possible. It is difficult, but it can be done. You can control what you eat. You can control that you don’t drink excessively, you can control that you don’t smoke, you can control that you don’t use drugs, I’m talking about recreational drugs. You can control the kind of sports you do.
Lifestyle factors are the things that we think can contribute to male infertility that are within our control, and those are the things that we are laying a lot of emphasis on.
How can IVF be used to help infertile males?
Nice question. IVF was first done successfully in 1978. Between 1978 and 1990, this question was answered because like you said, we sperm together with the egg, but we saw that there was some sperm when you mix them together with the egg, they don’t just do nothing. So, these are people whose sperm parameters are not good, the male factor.
Don’t forget that the conventional IVF itself was done for female factor, tubes blocked. So, so many methods were tried to see how these sperm samples that were not good could fertilize the eggs, not until a gentleman in Belgium was able to do what we now call ICSI (Inter-cytosplasmic Sperm Injection). So, that was the first time that the idea was imported, and since 1990, we’ve had babies from that ICSI procedure.
So, ICSI is what we do when the sperm count is bad. Many IVFs now are doing from 80 percent ICSI, some are even doing a hundred percent ICSI for their treatment to show you the kind of sperm that we are having now.
Also, we saw that from ICSI, that we are injecting sperms that normally will not be able to fertilize eggs because ICSI involves you injecting one sperm into the egg. What the sperm that is not good could not do was to penetrate the barrier that was shielding the egg, so we started injecting this sperm into the egg, so in essence, we were injecting sperm which normally could not fertilize the egg into the egg, and what we noticed over time was that the miscarriage rate was very high because we did not understand fully what we were seeing, but what we saw was that the miscarriage rate was higher. We would fertilize the egg alright, we would create embryos alright, some of the women will get pregnant alright, but the miscarriage rate was much higher because we were creating embryos that were not fit, but nature does not reject them until at the advanced stage, later on. So, we would have transferred, we would have said ‘we are pregnant’ and stuff like that before nature will now reject them because there is a quality control system in the body.
So, when people started seeing that, there was a need for us to be able to choose sperms, to be able to see that we filter the ones that are not good from the ones that are good.
Have Nigerians been able to embrace this advancement in medical practice and take full advantage of it?
When you are talking of these advanced methods, are we not talking about access? Because the services are available, but are people accessing them? And one of the barriers to access would be culture, like you said, which education is the main thing to that. Also, one of the things that are affecting access would be cost, can people afford it?
You know, there’s no amount of grammar that you will speak, and I know IVF works, if I cannot pay for it, it is still not accessible to me. So, when we talk about culture, I think culture is neutral about IVF. It’s not really a cultural issue, it is an awareness issue, it’s an educational issue, and it’s a cost issue. So, there’s no culture that says we shouldn’t do IVF; maybe religion, because there are some religions that say don’t do IVF, whether that holds water or not.
Will you advocate for sperm test among prospective fathers, and how regular do you advice that young men should go for sperm test?
Well, I don’t advocate for anybody doing sperm count or not, maybe before you get married, at least for you to know, so that it would guard your decision making. But what I say most of the time is that infertility involves two people. Even if I have a pass mark, my sperm is 200 million, and I marry, and I’m not able to impregnate my wife, as a couple, we have infertility. The thing is not for me to say ‘Oh yeah, my sperm count is good.’ So, you should only do sperm count when it is necessary, it is not something that a young man goes every year to be repeating. What are you doing it for?
So at what point is the sperm count test necessary?
Either if you want to get married, so that if your sperm count is not good, you know that your wife is not getting pregnant, so that you don’t start going from one prayer house to another. It’s not witches and wizard because you already know what the problem is, and you face it squarely.
So, should we now take it that there’s no cure for low or no sperm count?
If you use the word cure, there is none, but if it is whether it can be managed, then it is yes.
In the country today, how can we rate the successes of IVF?
I guess it’s a centre specific thing because right now, we still do not have national statistics, so it’s a centre-specific thing, and the problem with centre-specific data is that there is nobody who eats with the knife that’s lost, so most times, people claim what is not. I’m not saying it’s everybody, but sometimes people even claim what is ridiculous. So what I tell patients is that ‘you need to know that the technology was not invented in Nigeria.’ So if the owner of the technology says my technology can deliver 40 percent, and I sit down in my village and say I’m getting 70 percent, it’s either I’m wrong, I’m lying or I’m a witch. So you can decide whichever it is.
Looking at the cost implication, are there centres offering free IVF services?
Yeah! There are centres, there must be. We are also doing free services, but it’s just a drop in the ocean. How many free IVFs can you render in a year, or do you want to run bankrupt yourself? So it’s just a drop in the ocean. Anything that you want to be sustainable should be institutionalized. So, it’s either there’s an insurance agency or there must be a way to pay for it. There is no free lunch in Freetown.