By Bunmi Sofola (31-07-2017)

WHY do male doctors continue to lay blame for infertility on women? Do women themselves automatically assume infertility is their fault? Or could the driving factor be that invasive and complex fertility treatment for women are hugely lucrative for those carrying them out? These are questions urgently begging for answers as infertility problems continue to rise.

To the outside world, Babalola has an enviable life. Happily married to an attractive medical doctor with a comfortable home and a secure business, he is a father figure to his wife’s six-year old daughter from a previous relationship.

There is however, a yawning chasm in  Babalola’s life—his wife of four years was not yet pregnant after two years of marriage and it’s all down to his low sperm count. He is part of a silent epidemic of male infertility—a problem growing at an alarming rate and one which is now affecting thousands of young, otherwise healthy men. At least one in ten couples now need medical help to have a baby—and for half of them, the problem is as a result of poor sperm quality.

Infertility specialists fear this growing problem among men is bringing us closer to the day when most couples will need medical help to have a family. Last year, a major French study revealed sperm counts and quality have fallen sharply since the nineties. The trend is believed to be linked to diet, lifestyle and ‘gender-bending’ chemicals.

The researchers, who used data from 126 fertility treatment centres, said their conclusions constitute a ‘serious public health warning.’ But what is being done to alleviate the problem? For now, it seems, very little. Investigation has shown that most doctors barely address the problem of male infertility, choosing instead to focus on the woman if a couple seek treatment over their inability to conceive.

When Babalola and his wife went to their doctor after struggling for two years to conceive, the doctor referred them to a renowned gynaecologist—by definition a specialist in women’s problems, despite the fact that Kofo, Babalola’s wife must have been fertile because she already had a daughter from a previous relationship.

Kofo was subjected to several invasive examinations and tests which continued for more than a year, and at one stage left her with a dangerous post-operative infection. Unsurprisingly, they all showed she was fully fertile. It was only then that medical attention was directed towards Babalola. It was then tests showed he had a very low sperm count. The couple were at last referred to a male infertility specialist.

Babalola was distraught. “If they had checked me at the out-set,” he moaned, “they would have saved us money on the expensive tests on my wife.” Sam Abdalla, clinical director of London’s Lister Fertility Clinic, admits he is astonished at the ignorance about male infertility that seems to exist today.

According to him: “All the guidelines make it clear you do the basic tests on both partners before you do anything else. I can only think doctors who don’t specialise on fertility just don’t know men are as likely to be infertile as women.

On an average, out of the 200 million to 500 million sperm released during male orgasm, only 50 to 100 will complete the journey to the egg without getting lost or dying from exhaustion. The Journey can take up to six days. Only a few dozen will have sufficient strength left to attempt to drill into the

egg and only one will make it. This natural selection—ensuring only the healthiest sperm succeed—has propagated the human species for thousands of generations.

“It is now failing before our eyes, but the problem remains a taboo which many men—including doctors—find too embarrassing to discuss. It seems they would rather subject women to pointless and instructive tests than risk damaging fragile male ego.”

Babalola’s story bears this out. “It was after I was referred for tests that it was discovered there was problem with a blocked duct which meant I wasn’t producing enough sperm.

“Thanks to my wife’s medical background, we sought medical help abroad.” Kofo, his wife picked up the story: “Fertility tests routinely performed on women are far more painful and expensive than men’s. Apart from taking blood samples, to check hormone levels, dye is injected into the ovaries to

check eggs are being produced. The womb, the tubes from the ovaries and the ovaries themselves are probed under general anaesthetic using a keyhole surgery, and a different operation may be ordered to scrape tissue from the lining of the womb.

“Men, on the other-hand, are often not tested at all until after the women. A lot of doctors don’t really know that much about infertility and it doesn’t occur to them to check the men. With some couples, the fact that the infertility is due to a male problem may not even be mentioned. Thanks to my old

colleagues who are now in specialist hospitals, through whom the most current male infertility treatment called the ICSI—Intra Cytophasmic Sperm Injection—was used. Here a semen sample is scanned under a high-power microscope by a technician searching for a single healthy sperm to be injected directly into the woman’s egg in the laboratory. Thank God the treatment worked for us

resulting in our two twin sons.”

So why is male infertility on the rise? According to Sheena Lewis, Professor of reproductive medicine:”The number of men with infertility problems is growing rapidly. It is no longer a personal issue, it is a major public health issue. Environmental factors must be the cause, and if we don’t check out what they are and do something, the problem will escalate.

Evidence showing that sperm concentrations had halved since the 40s, first began to emerge 20 years ago. Since then, an avalanche of other research has shown sperm quality deteriorating year on year. Incidence of cancer of the genital organs in young men has also inexplicably doubled since the 70s.

Research published shows more than one in 20 baby boys is now born with undescended testis, trebling the risk of testicular cancer which usually strikes in young adulthood and often results in infertility.

“Chronic unfitness and obesity can also sabotage the reproductive capacity of men, and long-term harm from cigarettes can be passed from smoking father to non-smoking son. It’s also known that by-products from the plastic that mimic the effects of female hormones are damaging to sperm, as are by-products from car pollution.”

Another big cause of the infertility epidemic is the cult of self-fulfilment. On one hand, we are now increasingly promiscuous, suffering epidemics of Chlamydia and other sexually-transmitted diseases that affect fertility. On the other hand, couples are leaving attempts to become parents later and later, allowing age and increased exposure to lifestyle and risk factors to take their toll.