All you need to know about sperm injections

Sperm injection is one of the services Mulago specialised Women and Neonatal hospital is currently offering after the facility was officially opened on September 17. A number of people have been scratching their heads wondering what exactly the sperm injection procedure is, with the discussion dominating different social media platforms.

Meanwhile, others, do not even seem to understand why the hospital is charging Shs14 million for the procedure.
“The treatment is expensive because it is complicated,” says Dr Evelyn Nabunya, a senior consultant gynecologist and director at the Women and Neonatal hospital Mulago,

What are sperm injections?
Dr Charles Kiggundu, a consultant gynecologist at Mulago hospital, says the treatment targets men who fail to achieve their fertility goals adding that the procedure involves using a special technique to retrieve sperm from a man’s testes.

To elaborate, Dr Mark Muyingo, a reproductive endocrinologist working with Neogenesis Fertility Centre in Bukoto, Kamwokya, says the procedure is commonly referred to as Intracytoplasmic Sperm Injection (ICSI).
“The treatment is considered when there are factors affecting the quality of a man’s sperm or when a man has other fertility issues such as poor sperm movement or inability of his sperm to fertilise a woman’s eggs. ICSI involves getting a man’s sperm and then using a special clinical device to inject them directly into a woman’s egg so that fertilisation takes place,” Dr Muyingo says.

Muyingo adds that the procedure only has a slight difference from In Vitro Fertilisation (IVF).
“In ICSI, the sperm (that has been harvested from a man) is injected directly into an egg that has been extracted from a woman’s ovaries. It is like assisted fertilisation. On the otherhand, IVF involves placing eggs and sperms inside a liquid in a dish. The sperm is then given an opportunity to find an egg and fertilise it,” he says.
Usually, after fertilisation has happened in both procedures (ICSI and IVF), the (fertilised) eggs are carefully placed back in a woman’s womb.

The highs and lows
There are numerous benefits from this procedure, says David Zzimbe, an embryologist (responsible for retrieving eggs and assisting in IVF) at Bethany women’s and family hospital, Luzira.

“The treatment enables couples with partners who have severe oligozoospermia (sperm count below 5 million) to have children. This condition may not give chance to couples to conceive naturally because the male reproductive cells may not be able to meet the female reproductive cells in the fallopian tubes inorder for fertilisation to occur, therefore, ICSI bridges this gap by injecting the sperm directly into the female cells,” Zzimbe says, adding, “It is also recommended for those wishing to have children again after a vasectomy.”

On the other hand, Zzimbe notes that the risks from the procedure cannot be overlooked such as damage of both male and female reproductive cells during the course of treatment and also, the choice of sperm picked may result into embryos with abnormalities.
According to Zzimbe, ICSI is usually more expensive because it requires more expertise than IVF with different fertility centres charging different rates. Some may charge between Shs18m to Shs20 million.

Why I opted for it
One businessman who preferred to identify himself only as Okello, 60, told Healthy Living magazine that his sperms were retrived in 2014 after experiencing fertility issues.

“At the time [2014], I had just married my second wife who was 35 years old. We had tried in vain to have a child yet I had four children from a previous marriage. I knew there was something wrong and needed medical assistance,” Okello says.
It was until the couple visited a fertility clinic in town that Okello learnt that he had a low sperm count which was decreasing his chances of making the wife pregnant.

A fertility specialist recommended ICSI. “I did not welcome the idea at first especially when the doctor said they needed to get the sperm by either performing a small medical procedure that involves extracting sperm from my testes or I had to masturbate at the hospital so that sperm is obtained,” he says.

In the end, a testicular tissue was extracted directly from his testes through a process popularly known as Testicular Sperm Extraction (TESE). The procedure is taken by biopsy under local anesthesia.

Dr Alex Kakoraki of Murchison Bay Hospital, Luzira, says the procedure is more common in developed countries because, “Most developing countries lack the expertise and technology required for the procedure. He notes that it is the reason why most Ugandans are still unfamiliar of the practice.

The statistics
During the International Federation of Fertility Societies (IFFS) symposium that took place in March 2018, Sarah Opendi, the State Minister for Health noted that in Uganda, about 10 to 15 per cent of couples cannot have children due to infertility, and that 50 per cent was dependent on males. She advised couples with infertility issues to seek treatment at a hospitalrather than visit pastors or witchdoctors.

The Urology Care Foundation, one of the world’s leading nonprofit urological health organisations notes that about 13 out of 100 couples cannot get pregnant with unprotected sex. In over a third of infertility cases, the problem is with the man. This is mostly due to problems with his sperm delivery or production.