Low sperm count: Ugandan men's new headache

Like every newlywed couple, Rita (not real name) and her husband had dreams of loving each other to bits and have children. “A year passed with no signs of my wife conceiving. We did not worry. We knew it was a matter of time. But after three years, there was cause to worry,” Rita’s husband explains.

Frustration unfolds
“I suspected there was a problem with my wife’s fertility. I never imagined it would be my problem. I believed I was normal. I did what every man does right. I was “functioning” well. So how could it have been my problem? One morning, I asked her to go for a fertility check. She at first was hesitant but later agreed. We went together.

After the fertility doctor’s results, everything seemed surreal. “My wife was found to be normal. It felt like a sack of rocks on my shoulders. The doctor said, ‘Sir, it is your turn to get checked.’ I gaped at him as I asked, ‘You mean me, must I take the same test?’ he nodded, ‘yes sir’. Since we needed a solution to the problem, I held my breath, broke into cold sweats as I walked after him. It really was my turn to get checked. And guess what? I was found to be the cause of our childlessness. The doctor said I had low sperm count but had a slim chance of having children in future.

Costly medication
The doctor prescribed some medication. “At one point, a single dose cost me Shs980, 000. But my wife did not conceive. Back home I would kneel and pray; ‘Lord, I know I have few sperms and I know that I don’t need many. I need one, just one sperm to make my wife pregnant’. Nothing seemed to work. ” Friends kept encouraging the couple to stay hopeful. “We were in our ninth year of marriage but did not have children. Yet younger couples and friends who got married after us had children. But we did not have much to do about it.”

The good news at fertility centre
In their tenth year, the couple was advised by a friend to visit Women’s Hospital International and Fertility Centre, Bukoto. ”That is where we met a doctor that asked all sorts of questions. Some embarrassing like, ‘At what age did you start puberty? Do you take illegal drugs? And so on. Bottom-line, we needed a solution. The doctor prescribed medication. A few months later, my wife conceived. The following year we had a healthy child. It was just the beginning. My wife conceived again. I am now a proud father of three girls.”

Not so macho
The problem of low sperm count is one that men do not want to imagine. When a woman fails to conceive, the first suspect is often herself, not the husband. It is a silent fertility problem. The affected man retains his ability to function normally. He will have an erection and ejaculate. So on the outward; it’s difficult to tell one has the problem.

Yet as Dr Gilbert Ahimbisibwe, a gynaecologist at the Women’s Hospital International and Fertility Centre Bukoto says, the problem is widespread. “40 per cent of the couples that come with fertility problems, it is because of low sperm count. That means 3-4 of every ten couples we treat have low sperm count as the problem,” he says.

Tests
Having low sperm count is determined by doing four semen analysis tests. Ahimbisibwe explains that the first test is on the volume of semen. “A single normal ejaculation must have between 1 to 5ml of semen,” he says. The second test examines the number of sperms in the semen per ejaculation, the normal one being between one to 15 million sperms. The third is on mobility of the sperms. “The normal situation must have at least 50 per cent of the sperms moving during the first one hour of release,” Ahimbisibwe explains. The forth test examines the morphology of the sperm. That is its structure where at least 10 per cent of the sperms must have a normal structure.

The way it is difficult to identify so it is to point to the exact cause of the problem. “You can’t point out a single cause but an association of risk factors,” says Ahimbisibwe.

Causes
• Lifestyle and habits like smoking and excessive consumption of alcohol or drugs. Yet this is not absolute. “Some men may smoke and have normal sperm count. But there is a pattern between men who smoke and have low sperm count as opposed to those who do not smoke,” the doctor explains.

• Anything that exposes the testis to high temperatures such as laptops, steam baths, sauna and hot baths.

• Tight underwear. “It holds the testes so tight to the body creating heat that affects sperm production,” Ahimbisibwe adds.

• Infections of the testes or sperm tubes like inflammation of the testes. “Sperms may be produced but because of the infection, they either die or their movement is affected,” explains Ahimbisibwe.

• Cancers like the cancer of the testis or the chemotherapy as a result of other type of cancers

• Non communicable diseases like diabetes

• Having none or one testis at birth. “This means that the testes developed in the abdominal cavity which is abnormal and therefore won’t produce sperms,” explains Ahimbisibwe.

Prevention
• You should avoid some known factors that can affect sperm count and quality:
• Don’t smoke.
• Limit or abstain from alcohol.
• Steer clear of illegal drugs.
• Talk to your doctor about medications that can affect sperm count.
• Keep the weight off.
• Avoid the heat.
• Reduce stress.
• Avoid pesticides, heavy metals and other toxins

Treatment and cost
Ahimbisibwe explains that there are various causes and medical procedures that can be done but the treatment one gets depends on the exact cause of his low sperm count. “If you do not know the cause, then it becomes difficult to treat,” he says.

Surgery
For example, a swelling of the veins that drain the testicle (varicocele) can often be surgically fixed or an obstructed vas deferens tube repaired. A boy with none or single testis at birth requires surgery preferably before the child is nine years. “If it is not done in time, it becomes a permanent damage,” says Ahimbisibwe.

Treating infections
Antibiotics can cure an infection of the reproductive tract, but this doesn’t always restore fertility.

Hormone treatments and medications
Hormone replacement or medications may be prescribed to change hormone levels. It can take between three and six months before you’ll notice any effects on your semen analysis.

Assisted reproductive technology (ART)
ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.

Lifestyle and home remedies
Do not give up hope yet. And, going to the clinic is not the only way out. There are a few steps you can take at home to increase your chances of getting your partner pregnant:

Increase frequency of sex
Having sexual intercourse every other day around the time of ovulation increases your chances of getting your partner pregnant. However, ejaculating more often than that may reduce your sperm count.

Have sex when fertilisation is possible
A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. Experts generally recommend having intercourse every two days near the time of ovulation. This will ensure that sperm, which can live several days, are present when conception is possible.

Avoid the use of lubricants
Some products such as Astroglide or K-Y jelly, lotions, and saliva have been shown to reduce sperm movement. Ask your doctor about sperm-safe lubricants

When treatment does not work
Sometimes male fertility problems can’t be treated, and it’s impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.

Given the various causes of this problem, the cost of treatment varies from one patient to another.

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