With zero sperm count you can still be a father

With zero sperm count you can still be a father

Dr. Abayomi Ajayi

Infertility has traditionally been thought of as a woman’s problem. But as it turns out, men are also affected. About one out of every three cases of infertility is due to the man alone, and men are involved in infertility about half the time.

If you’ve been trying to get pregnant for 12 months without success, the best thing you and your partner can do is to visit your doctor or fertility clinic.

The reason is that infertility is a couple’s problem. A man could be affected as much as a woman. Even if either you or your partner has a child from another relationship, both of you should get tests done.

Common causes of male infertility, described as the “male factor” vary widely. Most often, the problem lies in the process of either making or moving the sperm.

Not being able to father a child can make you feel you have failed at one of your most primal responsibilities. If you’ve been trying to have a baby and it’s just not happening, you might have a low sperm count. Don’t panic. It’s actually one of the most common causes of male infertility. For many men, advances in male infertility treatment offer real help.

The good news is that there are new treatments bringing about more pregnancies for infertile couples with male factor infertility.

The goal of male infertility treatment is to ensure that as a man, you can achieve pregnancy and father a child. Sometimes, the cause of the infertility is reversible and conception can result from natural sex or In-Vitro Fertilisation.

By now, every regular reader of this column should know that sperms are made in the testicles. I have discussed this in some past editions, so you may refer to them for details.

However, I’ll remind you that sperms are stored inside the epididymis, which lies on top of each testicle. These sperms are nourished by semen, made by glands inside the vas deferens. During ejaculation, normally about 150 million sperm are released mixed with semen through the penis. This whole process depends on there being proper levels of testosterone and other hormones as well as correct signalling from the nervous system. Low sperm count means that the fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal.

A low sperm count is also called oligospermia. A complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per millilitre of semen.

Having a low sperm count decreases the odds that one of your sperm will fertilise your partner’s egg, resulting in pregnancy. Nonetheless, many men, who have a low sperm count are still able to father a child.

Now, it is reasonable to ask, what could cause you to have a low sperm count or abnormal sperm?

We will briefly talk about some of the problems responsible for this kind of infertility. Retrograde ejaculation is a good example. In this condition, semen ejaculates backwards into the bladder instead of out the penis. Usually a previous surgery is the cause. When you have such an abnormality, you may not produce enough sperms in an ejaculate.

Also, the absence of the main sperm-supplying vessel (known as the vas deferens) is a genetic problem. An obstruction can occur anywhere between the testicles and the penis to cause blockage of sperm delivery.

Antibodies can abnormally attack a man’s own sperm on their way to the egg. Up to one in four of infertile men have what is described as idiopathic infertility. That means they have abnormal or low sperm counts for no identifiable reason.

Varicocele is quite commonly associated with low or abnormal sperm parameters. It is an abnormal collection of bulging veins above the testicle.

Undescended testicles is another problem. Other causes include infections in the testicles (orchitis), the prostate (prostatitis), or elsewhere in the body that causes a fever.

In some cases, these problems can be reversed but other times they can’t. An evaluation is the only way to sort it out.

Sometimes, making sperm isn’t really the problem, rather, the problem is getting the sperm where it needs to go. If you are a man with this type of male infertility, you may have normal sperm in your testicles. But the issue is that the sperm in your semen is very low in number, or not there at all.

Do not lose hope because there is treatment and millions of men with such problems have benefited from available treatment. The fact is that several men with zero sperm count have become proud fathers of their own biological children.

In many cases in the past, the old fertility treatment methods didn’t work, and it meant lifelong male infertility. Today, however, assisted reproductive techniques such as Intracytoplasmic Sperm Injection are available. In ICSI, a single sperm is injected through a tiny needle into an egg. The fertilised egg is then implanted in the uterus. ICSI can be performed when sperm counts are extremely low or abnormal.

Modern male infertility treatments are available to give sperm an artificial boost to get into an egg. With such scientific advancement, conception is possible even for men with very low or abnormal sperm.

Sperm and semen analyses can help assess your sperm count, their shape, movement, and other variables.

Generally, a higher number of normal-shaped sperm means higher fertility but exceptions are common. You could be diagnosed with low sperm count or abnormal semen and still remain fertile. In the same vein, about one in five of infertile men are known to have normal semen and plenty of normal sperm.

If you don’t produce any active sperm in the ejaculate, it is often possible to extract sperm from the testicles. But are there things you can do on your own to maximise your fertility. For one, don’t do things to hurt your chances of having viable sperm. Hard drugs, tobacco, and more than two alcoholic drinks a day harm sperm production.

Diagnosis of male infertility brings about profound disappointment. For some men, no male infertility treatments seem to help. Finding out that you’re infertile can be an unpleasant surprise, to say the least. You may feel emotional stress with a diagnosis of infertility.

One thing you should not do is to confuse libido and potency with fertility. Most problems with male reproduction do not affect the ability to produce male hormones, sexual function or maleness. But even if things look bleak, there is always hope if you keep trying.

To know for sure if you have no sperm in the ejaculate, you need at least two semen analyses and at least one should be done using advanced sperm technology.

In general, there are four explanations why there could be no sperm in the ejaculate. One is that the testes are making sperm but there is a blockage. Two, the brain is not stimulating the testes to make sperm, or three, the testes are not producing any sperm. Lastly, the testes may be producing a tiny amount of sperm but it is not coming out in the ejaculate.

If sperm is produced but there is evidence of a blockage, the chances of getting your partner pregnant remains very good. If it is a reversible blockage, this can sometimes be fixed with a minor procedure.

If there is not a reversible problem such as a missing vas deferens (tube that carries the sperm), success rates of retrieving sperm approach 100 per cent. Pregnancy rates in this situation are usually greater than 50 per cent with IVF depending on factors such as your age, your partner’s age and the health of your female partner.

If you have no sperm at all in the ejaculate and there does not appear to be a blockage or a brain issue, can you still get your partner pregnant? The answer is yes. Men with no sperm in their ejaculate, who likely have a problem with sperm production can achieve pregnancy. All this is possible thanks to modern assisted reproductive techniques such as IVF and ICSI.

Sperm may be retrieved with either a minor procedure or a more extensive procedure based on your particular situation. The success rates in retrieving sperm are usually about 50 per cent in this situation.

The fact is that blockage can occur at any level including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.

When you don’t have enough sperm, there’s less chance that they’ll reach and fertilise the egg, which can lead to fertility problems.

Even if you have a normal sperm count, they still have to be healthy enough to make the journey from your partner’s vagina to the cervix and uterus to the fallopian tubes. If they’re not, you’ll have a hard time getting her pregnant.

Credit: PUNCH.

How to stay healthy during pregnancy — Expert

How to stay healthy during pregnancy — Expert

By Usman A. Bello, Benin

It is important for women to do some things and also avoid certain habits and practices in order to stay healthy during pregnancy as experts have said doing so also helps protect the health of the foetus up to birth and thereafter.

A Consultant Gynaecologist and Obstetrician, Dr. Victor Ohenhen, said certain peculiarities of pregnancy, including lifestyle and socio-cultural factors, predisposed pregnant women to illnesses and diseases.

Dr. Ohenhen explained that human pregnancy began from the point of fertilisation of the female gamete (ovum) by the male spermatozoa to form a zygote.

“It is important to stress that pregnancy is not a disease, but a normal process in the female reproductive cycle,” he said.

A mother of four, Mrs. Ifueko Omonigho, said observing health dos and don’ts during her pregnancy made her have “stress and disease-free pregnancies”.

Mrs. Omonigho said it also contributed in ensuring her children were healthy even after birth.

Dr. Ohenhen, who is also the Head of Department of Obstetrics and Gynaecology of the Central Hospital, Benin, Edo State, gave the following tips for staying healthy when pregnant:

Plan every pregnancy: Adequate planning improves outcome for both mother and baby. Also, because every pregnancy takes its toll on the health of the mother, it is important to avoid getting pregnant frequently. It is recommended that women give at least a two-year gap between pregnancies.

Seek care early: Seek ante-natal care early. It is advised that the pregnancy is booked at the second missed period to allow for early identification and treatment of possible problems.

Get plenty of sleep: Getting between seven to nine hours of sleep per day keeps the pregnant woman refreshed and mentally alert. Also, midday naps are an excellent choice during pregnancy.

Reduce stress: Stress wears the body out. It is, therefore, wise to limit activities when pregnant. Get help for certain things beyond your reach whenever possible.

Eat right: Eating the right meals in adequate proportions ensures that you and your baby stay healthy throughout the entire pregnancy period.

Get a support system: This is one aspect of staying healthy that is too frequently ignored. The pregnant woman needs assurance and guidance from her social network. It is not a time to live in isolation but a period to build support systems. This is important for her mental health.

What to eat and do when pregnant

Dr. Ohenhen also advised that women should eat or do the following:

Water: Simple things mean a whole lot during pregnancy. Pregnancy increases your need for water due to a drop in plasma volume that occurs. Water helps to prevent constipation, haemorrhoids and Urinary Tract Infections (UTI). It is recommended that a pregnant woman takes at least eight cups of water daily.

Fruits and vegetables: The importance of fruits cannot be overemphasised. Fruits like avocado are an excellent source of Vitamins C, E and K. They are also rich in fibre. Spinach and orange are rich in folic acid, an important nutrient that helps to prevent neural tube defects during the early phase of pregnancy.

Legumes: Legumes are a superb store of protein, iron, folate and calcium. Examples of legumes are beans, soybeans and groundnuts.

Sweet potato: They are rich in beta carotene that is converted to Vitamin A which is important for a healthy diet.

Eggs: Eggs are the ideal health food because they contain a little bit of almost all nutrients. They are a great addition to your meals during pregnancy.

Lean meat: Moderate amounts of beef, pork and chicken are excellent sources of high quality protein.

Exercise: Reasonable degree of physical activity that suits your tolerability is helpful when pregnant.

The medical expert also advised that women should not eat or do the following when pregnant:

Alcohol: Alcohol consumption during pregnancy is a harmful habit that has well documented effects on the developing child. Examples of these are birth defects and slow growth of the baby referred to in medicine as Intrauterine Growth Restrictions (IUGR). Alcohol consumption, especially when heavy during pregnancy, causes Foetal Alcohol Syndrome (FAS).

Herbs and plants: Pregnancy period is not a time to use herbal products or supplements as this may result in very serious conditions in the baby, especially congenital defects at birth.

Caffeine: Several studies have shown a link between high amounts of caffeine intake and miscarriage.

Junk food and refined sugar: These are not advised during pregnancy due to their effects on the child. It is important to limit the consumption also of carbonated drinks during pregnancy.

Cigarette: Cigarette smoking generates a number of free radicals which immensely affect the health of the baby.

Dr. Ohenhen added that pregnancy period was an exciting time and should be regarded as such.

“With proper health behaviour and adequate diet, a healthy baby and mother is the outcome of the nine-month ‘journey’”, he said.

Credit : Daily Trust

It’s not advisable to use tissue paper during menstrual period —Researcher

It’s not advisable to use tissue paper during menstrual period —Researcher

A medical researcher, Dr. Bamidele Iwalokun, on Thursday condemned the use of tissue paper as sanitary pads by women, saying it could lead to severe health complications.

Iwalokun, who is the Head, Immunology and Vaccinology Research Department, Nigerian Institute of Medical Research, Yaba, said this in an interview with the News Agency of Nigeria in Lagos.

He said that some tissue papers were products of waste paper, and such tissue papers were not hygienic for draining blood during menstruation.

“The habit of using tissue paper in form of sanitary pads is a poor hygiene practice on the part of any woman.

“Because no health policy has supported the use of tissue paper as sanitary pads, it’s a bad behaviour and should not be adopted.

“It doesn’t have any credibility of use. This should be a way of informing women that it carries a serious public health risk.

“The practice places such women at risk of having infection, which may pass through the vagina cavity and enter the bloodstream, creating serious health problems,” Iwalokun said.

The researcher said that the use of tissue paper during menstruation could affect the reproductive organs and that it could lead to other health complications.

“Sometimes, it may be chronic infections that may not give serious symptoms to warrant going to the hospital, but it is indirectly damaging the reproductive system or that pathway.

“One of them is the Pelvic Inflammatory Disease, which many women may not know they have until when issues of infertility comes up, as untreated PID is a major cause of infertility.

“It also depends on the pathogens that are coming from such paper; so, it is important to identify the types of pathogen that are isolated from such tissue papers.

“There must be quality study that will show the various types of pathogens, in order to identify the type of damage it can cause.

“However, women should abstain from the practice of using tissue paper as sanitary pads, in order to avoid such health complications.

“Women should always adopt proper hygiene at all times, especially during their menstrual period,” he counselled.


How to overcome low sperm count

Low sperm count: How to overcome it

by Dr Joel Akande

Low sperm count or as it’s called in medical world, oligospermia, is a major biological and reproductive issue. At the risk of being accused of hyperbole, low sperm count puts survival of humanity at risk. There is no doubt that in some parts of the world, population is increasing such as in Nigeria. But in other regions of the earth, population is diminishing. We all know that even within a country such as Nigeria where population increase is a problem, not everyone desiring a baby gets one because of low sperm count. Low sperm count is common in Nigeria and the rate is increasing, especially amongst the young generations.

All said, the individuals that are suffering from low sperm count are, obviously, very concerned as I have seen in my fertility practice on so many occasions. As the reader may know, a third of infertility issue is due to male issue which in the end is due to low sperm count. Another third is due to female and the couple together shares the remaining third. Yet, in the male factor, low sperm count or oligospermia is a major contributor and indeed, the most significant contributor to the male infertility problem. Quantity or count of sperm is just a part of the sperm problem. Sperm numbers, to be effective, should be in the order of at least 20million. That is not the end of the story.

Quality of the sperm is another great concern. For sperm to be of good quality, the sperm must be able to move actively and freely within the suitable environment of the reproductive tract of the female. The individual sperm must be free from structural abnormalities in shape and form. Fertility doctors are most concerned with sperms that are dead or sluggish even if the quantity is sufficient. Sperms must be able to penetrate the covering of the female egg before or just prior to fertilisation taking place. Failing, low sperm count and low quality of sperm remain a challenge for the childless and the attending fertility physicians.

What causes low sperm count? The life style of men accounts for a significant cause of low sperm count. Obesity and being overweight are major causes of low sperm count along with hypertension and diabetes. Nicotine or cigarette consumption is another reason. Heat around the male reproductive organs (testes and scrotum) constitutes a danger to male fertility.

Heat could impair the normal development of sperms. Heat from wearing tight pants, long distance driving and soaking the testes in hot water bath, are not friendly to sperm development. Heat from long use of laptop placed over the scrotum is a danger to sperms. There is a speculation also of mobile phones placed near the testes, causing impairment to normal sperm development.

Occupation as drivers as well as working in places where one is exposed to industrial chemicals may lead to low sperm count. Medically, infection such as HIV, gonorrhoea, Chlamydia and mumps to mention a few, which may interfere with sperm production, could lead to low sperm count and of poor quality. Remember also that infection from the female reproductive tract may be transferred to the male partner to cause sperm abnormality.

Cancers of reproductive tract may impair sperm development. Ejaculation problem, retrograde ejaculation should be noted as causes of low sperm count. In some cases, testes that are not descended into the scrotum and growths that affect male reproductive tracts are other reasons that account for low sperms. In some unfortunate cases, the sperm may suffer from anti-sperm antibodies that work against the sperm itself.

We should also bear in mind that genetic abnormalities such as Klinefelter syndrome could affect development of the testes and of the sperm production. Some medications even when legitimately prescribed could affect sperm production. This category includes chemotherapy, some antifungal, anti-ulcer medications and antibiotics could all work against sperm quality and quantity. Substances and drug abuse such as cocaine and marijuana could reduce the quality and quantity of sperm

Prevention: Stop smoking. Avoid heating the testes. Avoid hot water bath. Readers in cold clime may have to use shower instead of bath. Wear loose pants or as is recommended, wear boxers instead of pants. Stop use of alcohol and steroids if they are responsible for the low sperm count. Avoid misuse of drugs. Severe and prolonged mental stress could cause low sperm count. Avoid stress whatever it takes. Pesticides could affect sperm count. Avoid it. If you are overweight and obese, lose weight. Regular, structured exercise has been shown to benefit and improve quality of sperms and thus improve conception chances.

Solutions: Thankfully, some of the problems that cause low sperm count can be both prevented and treated. Drugs and medications that cause oligospermia can be stopped to allow the testes and sperm production to recover.

In some cases, surgery may be required to correct any abnormality discovered. There are some supporting medications, which fertility doctors can use to boost sperm quality and count. If everything else fails, fertility treatment such as in vitro fertilization or assisted conception may be called for.

Credit: The Nation

Excess ginger consumption can cause miscarriage

‘Excess ginger consumption can cause miscarriage’

Dayo Ojerinde

A Paediatric nurse at the Life Line Children Hospital, Lekki, Lagos, Mrs Alexis Essien, has cautioned pregnant women against consuming excess ginger.

Essien, in an interview with our correspondent, said that ginger could cause heartburn for those with an ulcer.

She said, “Ginger has many benefits for pregnant women if consumed in moderation. However, if you consume excess amounts of it during pregnancy, it may lead to miscarriage.

“It is not considered dangerous if what is consumed is less than 1500mg, but a pregnant woman should check with her doctor before consumption. Ginger may affect the blood sugar levels of pregnant women. For those with gestational diabetes, it is best they consult their doctor if they wish to consume ginger during pregnancy.”

She also advised pregnant women to avoid ginger if they had a history of vaginal bleeding, dizziness, clotting disorder or miscarriage.

According to parenting.firstcry.com, moderate consumption of ginger by pregnant women helps regulate cholesterol levels and boosts the blood supply to the foetus as well.

By consuming ginger, the blood circulation in your body gets spiked up. This boosts the blood supply to the foetus as well.

Ginger is effective in providing relief from nausea and morning sickness. It may help the body to absorb nutrients from the food consumed.

Taking ginger before bedtime helps to ease pregnancy-related indigestion, gas and bloating. It also helps to ease muscle pains and aches during pregnancy.

Moderate consumption of ginger during pregnancy improves the supply of iron and Vitamin C in the body and helps in boosting the baby’s immune system.

Source: The Punch

Six reasons some women slide into early menopause

Six reasons some women slide into early menopauseTunde AjajaThe discussion about menopause, which signals the end of a woman’s menstrual cycle, seems to have assumed a more diverse and interesting dimension in recent years following the recent cases of women who, in their 60s and 70s, have been delivered of babies.Even though most of such cases were more often than not a product of in-vitro fertilisation technique, popularly known as IVF.This process involves fertilisation of eggs outside the womb in a laboratory dish or a test tube before the embryo is transferred into the woman’s uterus for development.For example, just few weeks ago, a 66-year-old woman, Mrs. Ajibola Otubusin, was reportedly delivered of her first child, a baby boy, after 40 years of marriage.Given her age and several attempts to conceive, she said that she initially didn’t believe it was true. But, as it turned out, she had her baby.Earlier in the year also, a 63-year-old woman, Margaret Davou, in Plateau State was reportedly delivered of a baby girl; her first in her 38 years of marriage to her husband, 67-year-old Francis.The issue of having delay in childbirth is no doubt a global challenge. A 72-year-old Indian, Daljinder Kaur, was in 2016 reportedly delivered of a baby boy after 46 years of marriage.Perhaps, the age of the women would justify why they had to resort to IVF, given that menopause occurs in women when they are about 50 years old, even though it also varies among individuals.But, on the other hand, there have been instances where younger women slide into menopause, a phenomenon that is known as premature menopause.A report released by London’s Imperial College few years ago shows that women, arguably, now seem to reach menopause earlier than it used to be in the past. The average age for menopause used to be about 60, unlike now that it seems to be about 45 years.And given that several factors could be responsible for delay in getting pregnant, premature menopause may not be detected early. And such was the case of Janet, a 39-year-old mid-level marketer, who had been married for about 10 years.She revealed that initially when she didn’t conceive, despite the frequent and timely sexual intercourse with her husband, doctors told her it was stress, as she spends hours in traffic and she is oftentimes out of the office for fieldwork.But even after quitting her job and settling for a less-paying and less-taxing one, nothing changed, which according to her prompted her to go for more comprehensive medical tests. But the results broke her heart beyond what she could comprehend.She said, “I noticed that my period was irregular and sometimes I missed it. As you can imagine, I thought it was a good signal, but it was far from it. Anytime I had a period, it was either lighter or heavier than normal.“After some time, I started having lower sex drive and of course, vagina dryness came with it and I needed to lubricate myself anytime we were to have sex, because as much as I was losing interest in sex, I knew we had to do it to stand a chance. My husband also told me I had mood swings.“At the end, I was told that I was producing less oestrogen and that I had suffered premature menopause. It was like the world ended that minute – having menopause at my age. My thoughts ran wild and I was losing it.”After several counselling sessions and encouragement from her husband, she said she went for IVF and now has two children. “I wasn’t happy until the IVF was successful and I could see my own children,” she said.The foregoing underscores the fact that there are women who suffer from premature menopause.A seasoned consultant endocrinologist, Dr Michael Olamoyegun, explained that for most people, menopause age usually ranges from 50, plus or minus five years, which means it’s from 45 to 55 and some people could reach menopause at age 57.“So, it could vary, but if it occurs before 45, that is premature menopause,” he added.Thus, apart from age, which is primary and the most relatable, it would seem helpful to identify the factors that could make women reach menopause prematurely, some of which include:Genetics: This is one of the factors that experts have identified as one of the causes of premature menopause. Olamoyegun explained that even though it is a potent factor, it does not mean that every woman (daughter) in a family would experience it because the mother reached menopause early. He said there was only a higher likelihood that they could follow the same pattern.He said, “It tends to run in families and that is why we said it is genetic. However, it is not a certainty that the daughter would reach menopause at the same age the mother did, but there is a higher likelihood that the daughter would experience the same thing. However, if the daughters are prone to other medical conditions like obesity, it could increase their chance of experiencing it.”Surgery: This is perhaps one of the most critical causes of premature menopause as it could impact directly on the hormones responsible for the menstrual cycle. Olamoyegun explained that if a woman undergoes surgical procedures that remove the ovary, which is the female reproductive organ where eggs are produced, the woman, regardless of the age, tends to invariably slide into menopause because the hormone that controls menstrual cycle comes from the ovary. Thus, once the ovary is removed, the source of the hormone responsible for menstrual cycle has been removed and so the woman is unable to menstruate or produce eggs, which is tantamount to menopause.He said, “The hormones that control menstrual cycle come from the ovary and once you remove the ovary, for whatever reason, you have removed the source of those hormones and so the woman cannot produce eggs because what happens in menopause is that the ovary is not releasing eggs, which is why somebody that has attained menopause cannot give birth to children, except through IVF.”He explained further, “Let’s say somebody has cancer of the uterus, she can decide to remove the uterus (hysterectomy), and sometimes they remove the ovary as well because if you have removed the uterus, the ovary is of no use again. Also, if somebody has fibroid, instead of doing myomectomy, which is the removal of the fibroid, some women remove the uterus and ovary as well if they have completed childbirth. In such cases, they have reached menopause.” He added that in some instances, women could be placed on hormone replacement therapy so as to reduce the manifestation of the lost hormones.Cancer chemotherapy: This is the use of certain drugs to treat cancer, and according to Olamoyegun, there are instances where this could affect the ovary. He added that once the ovary is destroyed, such a woman may stop producing eggs or menstruating.He said, “Chemotherapy may affect the ability to produce hormones required for menstruation,” he said. “When somebody has cancer of the ovary, abdomen or of any area around that region, and the person does chemotherapy, as it destroys the cancer it’s also destroying the ovary and the ovary won’t be able to produce the hormones required for menstruation again.”It was learnt that the type of chemotherapy used would determine whether the person would go into menopause or not.Radiation: While this may seem unpopular, it is another factor that causes premature menopause. Experts have said that pelvic radiation therapy for reproductive system cancers could cause ovarian damage. He said, “You know radiation is also used for treating cancer, so when someone is exposed to radiation, it can affect the ovary and the person might have premature menopause, depending on other things like the extent of the exposure to the radiation.”Autoimmune factor: Researchers have said that there are times the immune system in the body fights itself, and that if it attacks itself in the region of the reproductive organs, it could affect the ovary which makes it impossible for it to produce hormones that are needed for menstruation.Olamoyegun said, “This is when the body produces chemicals that destroy itself, so there can be immune diseases that destroy the ovary and it can start anytime. And once the ovary is destroyed, the person would not be able to produce hormones needed for menstruation and the person would face premature menopause.”Meanwhile, WebMD, a website where experts provide valuable health information, pointed out that thyroid disease and rheumatoid arthritis are two diseases in which this can happen.Lifestyle: This seems to be one factor that impacts people’s well-being in all aspects of their lives, and it appears reproductive health is not spared in this regard. Olamoyegun explains that even though there is no established link between things like obesity, smoking and premature menopause, they may possibly be risk factors.He said, “Things like obesity, smoking and inhaling certain chemicals and alcoholic drinks cause many problems such as hypertension, diabetes, high cholesterol and other things and even though lifestyle has not been shown scientifically to cause premature menopause, it is not impossible. But, like I said, it has not been established.”The endocrinologist advised that it was important for people to pay attention to the factors identified, noting that “once you enter menopause, medically, the only solution in terms of childbirth is IVF, so people should exercise care with their system.”Source: The Punch

Why doctors request sperm analysis

Why doctors request sperm analysis

Dr. Sylvester Ikhisemojie

Sperm analysis is usually described as seminal fluid analysis. It is one of the most commonly requested tests on bodily fluids in all hospitals and is frequently asked for in pursuit of the causes of infertility among married couples. Seminal fluid analysis is also sometimes called a seminogram. This is broadly speaking, the laboratory analysis of a sample of seminal fluid produced by a man. It analyzes the health, viability and characteristics of semen and it consists of the determination of the volume of semen produced by an adult male; the number of sperms contained in the fluid and the acidity or alkalinity of the semen produced. It also involves the examination of the shape, the motility and viability of the sperm. Semen, which is used here interchangeably with seminal fluid, is the thick whitish fluid produced by the male organ during ejaculation. In the laboratory, such a product is referred to as the ejaculate.

Seminal fluid varies in volume at ejaculation; it varies in volume between two and five milliliters but may be up to seven and a half milliliters in some men or as low as one and a half milliliters which is regarded as the lower limit of normal. Normal semen should contain a minimum of 15 million sperm cells in each milliliter of seminal fluid, a downward revision by the World Health Organisation from the old figure of 20 million.

The upper limit is in the region of 225 million per milliliter of seminal fluid. The total number of sperms in each ejaculate may therefore range between 45 and 950 million sperm cells. However, for clinical purposes, the sperm count is often expressed as a certain number of sperms per milliliter of fluid. Seminal fluid is itself made up of between 96 and 98 per cent of water. Therefore, one way of making certain that a man produces more sperm is to drink more fluids. Other ways of ensuring that are as follows; avoid genital tract infections; avoid frequent sex at less than 48 hours apart; do not engage too frequently in masturbation.

With these parameters in mind, a doctor who requests a seminal fluid analysis determines to see the above parameters reflected in the result after the man has avoided sex for at least 48 hours. Many clinicians want an even longer wait with the semen being produced on the fourth or fifth day of abstinence. In addition to the volume and the cell count, the doctor also wants to have an idea of the colour of the semen; its viscosity and whether or not it is compromised by a bacterial infection. A volume less than one and a half milliliters often means that the seminal vesicles, which transport the semen from the testes to the urethra, could be partly or completely blocked. It may also indicate the presence of an infection or certain problems with the prostate. The doctor’s knowledge of the various organisms active in that part of the body would show rather quickly whether there is a genuine infection or a contamination with bacteria. Such contamination can occur when the sample to be studied is not collected in the recommended way thereby allowing surrounding bacteria to get into the semen either within the collecting vessel or before it gets into it. When there is an established infection, such an infection is treated energetically with the required antibiotics based usually on the laboratory’s report.

The next characteristic of interest to the doctor is the physical nature of the various sperm cells also called their morphology. The prevalence of certain variants from what is considered normal is a predictor of the severity of infertility in a male. Therefore, if there are sperms with double heads; twin tails or other such abnormalities, they are not only considered as unable to fertilize an ovum but that they could even cause some damage to a foetus if such fertilisation occurs. Morphology considered acceptable is when at least 60 per cent of all the sperms are determined as normal. This is why increasingly; semen analysis is now one of the most commonly requested tests in men when investigating infertility. This is because abnormalities of the sperm are common while the test is relatively easy to perform. It is not considered to be an invasive kind of test; it is cheaply done and any trained laboratory scientist can do it reliably.

It is because of the reasons elucidated above that doctors often request the analysis of seminal fluid. Frequently, it is performed as a part of the investigation and treatment of infertility. In other cases, it is performed to determine the effectiveness or success of a vasectomy. Since the latter is very rarely performed on Nigerian men, it follows that seminal fluid analysis done in Nigeria are almost universally triggered by the investigation of infertility. Despite all of that, it remains a major task persuading many men to have that investigation done. One has worked before with senior colleagues who had to recourse to writing notes to husbands that insisted they were fine while feeling comfortable to have their wives undergo all kinds of investigations in pursuit of a pregnancy. Yet, there are some who would refuse.

The analysis of freshly ejaculated semen is one of the most useful investigations performed in the quest for unraveling the cause of a couple’s infertility. It should be performed early in the investigation of the couple. It is easy to perform and very convenient even though Nigerian men frequently resist that. It is when nothing wrong has been found with the seminal analysis that attention should turn to the woman. By a fresh ejaculate is meant one which is presented at a competent medical laboratory within one hour of being produced. At presentation in the laboratory, its colour, viscosity and volume are quickly noted as well as the time it takes it to liquefy. Only after all these are done should attention turn to the cellular count. The semen is usually produced either in the comfort of the couple’s home or at a suitable location within the laboratory or hospital. It may be the product of actual sex interrupted at the point of ejaculation to allow the emission into a sterile container; or the performance of some suitable sex act to bring the man to that point or through masturbation. In men who have become paralyzed as a result of a spinal cord injury or disease, and are unable to achieve an erection, it is possible to obtain their semen by aspiration using special needles for that purpose so that the specimen can be analyzed or used for assisted reproduction techniques.

It is important to know that semen is not the same thing as sperm even though the two terms are often used interchangeably. Seminal fluid is made up of sperm and water. The water component is made up of prostatic fluid in which the sperms swim. As we have seen above, the volume can be increased by taking in more fluids. This can also be boosted further by increasing the intake of vegetables and fruits as these will supply increased volumes of vitamin C for the increased motility of the sperms. Raised levels of the male hormone, testosterone, also promote the rise in the volume of seminal fluid. Prolonged fore-play during sexual intercourse is also thought to increase the intensity of an orgasm such that the volume of seminal fluid also rises.

Source: The Punch

How exposure of scrotum to heat contributes to male infertility

Elevated scrotal temperature as major cause of male infertility

Prof. Oladapo Ashiru

The Fertility and Sterility Journal published the most current definition of infertility in its September 2017 edition. It defined infertility as a “disease characterised by the failure to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner.”

Fertility interventions, it added, may be initiated in less than one year, based on medical, sexual and reproductive history, age, physical findings and diagnostic testing.

The publication also described infertility as a disease, which generates disability as an impairment of function.

The new definition was arrived at a meeting held by 50 experts on fertility in Geneva and it will be adopted by the World Health Organisation.

This definition underscores the fact that male and female partners are responsible. Furthermore, the responsibility as regards the causes of infertility is 50 per cent in the male and 50 per cent by the female partner.

Causes of infertility

In sub-Saharan Africa, the prevalence of infertility has been notably variable, ranging from 20 to 46 per cent. About 30 per cent of infertility is due to female problems, 30 per cent to male issues and 30 per cent to combined male/female issues, while in 10 per cent there is no recognisable cause.

In Nigeria, the prevalence is between 20 and 25 per cent among married couples.

The causes of infertility have been divided into two main categories: Male infertility, which is principally due to reduced semen parameters and Female infertility, which is due to factors, such as occlusions of fallopian tubes, uterine or endometrial abnormalities, abnormal cervix and anovulation in the female partner.

The primary cause of male infertility is poor sperm count and concentration, poor motility and morphology or a combination of the above. Factors that can lead to male infertility include exposure to heat for prolonged periods, especially the scrotal region; exposure to radiation, environmental pollutants, genetic abnormalities, heavy use of alcohol, smoking, etc.

Latest studies have shown that elevated scrotal temperature is a major cause of male infertility as mentioned above. It is known that testicular function is temperature dependent and it requires a temperature of 2 degrees Celsius to 4 degrees Celsius below core body temperature, which is why the scrotal sac is situated outside of the body.

Scrotal hyperthermia is a well-documented mechanism of abnormal spermatogenesis associated with male infertility, thus maintaining a temperature difference between the body and scrotal sac is crucial to ensure the production of normal spermatozoa.

Modern technology has not been kind to the male reproductive system and it has been linked to having a significant impact on raised scrotal temperature, such as the use of laptops on the lap, EMF from cell phones positioned to close the scrotum, prolonged car driving and sports cars, heated car seats, tight clothing, and others.

Causes of elevated scrotal temperature

Laptop Computer

The Laptop Computer is an active heat-generating device that exposes the scrotum to the dissipated high internal operating temperature. A working LC in a laptop position causes significant scrotal temperature elevation by a direct heating effect of the LC and also by the dependent sitting position, with closely approximated thighs, that is necessary to balance a LC on the lap.

Balancing laptop computers on the lap has been found to raise the scrotum’s temperature to around a 5 degrees Fahrenheit increase (or about 2.7 degrees Celsius) and it has been shown that sperm concentration and motility dropped by 40 per cent when median daytime scrotal temperature rose by 1 to 2 degrees Fahrenheit (or 1 degree Celsius).

Electromagnetic waves from cellphones

The frequency of incoming waves and subsequent energy of transmitted waves by the cell phone device can have an effect on not only the general body but also more specifically on the male reproductive system. This EMF has a detrimental impact on the motility and characteristics of spermatozoa, leading to a significant decrease in the percentage of forward progressive motile sperm. Also there is a substantial increase in the rate of mitochondrial ROS production and the level of 8- OHdG (Reactive oxygen species, and free radicals that can alter the DNA and genetic composition of cells). It was concluded that RF-EMW emitted from cell phones may increase oxidative stress in human spermatozoa leading to decreased motility and viability characteristics.

Studies showed that for heavy users of cell phones, sperm counts were 30 per cent lower than men who did not use a cell phone.

Therefore, exposure to cell phones may be correlated with the significant decrease of melatonin in the body, making spermatozoa more susceptible to reactive oxygen species attack. Thus, the effect of cell phone EMW on the generation of oxidative stress cannot be ignored. The consequence of such ignorance may be dismal in regards to male infertility and possible cancer in the future. That is why most mobile phones are sold with an earpiece.

Heated surfaces and sport cars

Heat from the front engine surface or heated car seat (especially sports cars due to the closeness to the front engine) further adds to scrotal temperatures that are already elevated from being in a seated position.

Professional sports car drivers or occupational drivers and individuals who have long daily commutes are more prone to having increased scrotal temperatures, poorer sperm quality and longer time to achieve pregnancy. The adverse effect of long hours of driving and seated commuters increases in severity with the number of years spent engaging in such activities.

Tight underwear

Although the effect of tight underwear versus boxer shorts on sperm parameters is inconclusive, it would seem that tighter-fitting undergarments would leave less room for scrotal movement and air circulation hence contributing to higher genital temperatures and in turn lead to increase in scrotal temperature. That being said, a choice of clothing that encourages good air flow could minimize the deviation of physiological scrotal temperatures.

Hot bath and sauna

The use of hot baths and sauna for relaxation and rejuvenation may make one feel better, but it also hurts semen quality. Full-body immersion in a warm bath, hot tub, heated Jacuzzi or whirlpool at temperatures over 36.9°C for 30 min or more a week for three months or more leads to wet hyperthermia, which could have a reversible negative effect on sperm motility. Users of conventional saunas experience moist heat and warmed surfaces, whereas modern infrared-type saunas offer dry, radiant heat.

Studies show that after sauna exposure, scrotal temperatures reach up to body temperatures within 10 minutes, and there is a significant but reversible negative effect on spermatogenesis. At temperatures ranging from 80 to 90°C, and at different frequency and duration of exposure, the use of saunas could disrupt spermatogenesis and cause abnormal sperm count and motility. Usually a cold ice towel are provided outside the sauna and steam to cool down.

Occupational or residential heat exposure

Another factor that may contribute to heat stress in the male is ambient heat caused by hotter environmental temperatures where a man lives or works. Specific labour intensive jobs entail exposure to long periods of extreme, radiant heat. Welders, for example, are exposed to extraordinary levels of heat, toxic metals and fumes during welding. Studies involving these workers demonstrate a reversible decline in semen quality.

Those working directly with sources of severe weather, such as bakers and ceramic oven operators, have a longer time to pregnancy, which suggests that occupational heat exposure has an effect on fertility. Men who work in close range to sources of intense heat, such as the rear end of a submarine (location of the motor) seem to face infertility-related problems.

Credit: The Punch

Exercising and coping with increased body heat in pregnancy

Exercising and coping with increased body heat in pregnancy

By Eziaha Bolaji-Olojo,

If you think the weather is hot, you should get some perspectives from a pregnant woman, especially in the latter half of pregnancy. In addition to the other niggles and relative inconveniences it may bring, pregnancy also increases the amount of heat a woman feels internally and emits externally especially via her sweat glands. Simply put, a woman sweats more when she is pregnant especially if second and third trimester meets her in the hot seasons.
As pregnancy progresses, the rate of metabolism and fat burning in the body even without exercising also increases, manifesting in faster heat emission externally. Metabolic changes, how the body breaks down food to create energy for the growing and developing fetus, plays a role in increased sweating. Also in the extra blood volume and body fat which is needed to provide extra insulation for the woman’s changing body. The placenta which helps in the exchange of oxygen, blood, and nutrients between the mother and fetus generates heat as it carries out its vital functions. All of these, and more makes a pregnant woman even hotter.

And the sweating, is necessary because it provides a conduit for all that internally generated heat to find outward expression, guarding against internal body stress and possible shock. It is important to note that all these happen even when a pregnant woman is at rest. For a pregnant woman who exercises, the sweating is even more.

While there may not be much to be done against these biological processes within the body, a pregnant woman who is also exercising can help manage her body heat by putting a few measures in place both for her convenience and safety. The most important tip is to stay hydrated at all times, especially when working out.

An expectant mum needs to drink more water than a non-pregnant one. Always have a bottle of water with you and don’t stop drinking. The chore of having to pee is far less disturbing than dealing with increased internal body heat. Water, even at room temperature, cools the body from within. You probably understand why it is safe for a pregnant woman to drink cold water.

There is nothing wrong with cold water so long as there are no conditions that contraindicate it, and you can actually keep it down without feelings of nausea. On a personal note, I had no issues drinking cold water because that was what I preferred especially as I consistently worked out and felt hot most of the time.

Take frequent water breaks while working out. When not actively expending energy via physical activity and at rest, keep hydrating. When you wake up at night to use the bathroom, have a glass of water too. Another important way to manage body heat when working out is your location. Taking a walk outdoors in favourable weather is a great way to cool down as you sweat. Some pregnant women even love to work out in the rain. Take advantage of the cool breeze of the early mornings or late evenings.

If working out indoors, ensure the place is well aerated whether naturally by opening windows, or artificially with cooling devices like fans and air conditioners. If you use a gym, you can ask for a fan be stationed in a way that favors you primarily for the time you spend there.

Also, your workout clothing is very important. Except the weather is cold, avoid hoods and slacks made from thick cotton material. Shorts. A firm sports bra and a light and loose-fitting top will keep you comfortable through a workout. If at home and have some privacy, it is ok to dress as minimally as possible.

Finally, a couple of fruits help keep you feeling hydrated as their water content is very high. Fruits like watermelon, oranges (also a perfect post-workout snack), cucumbers, pineapples, and more. Most of them are low in sugar and calories and so make a great snack at any time of the day. Be generous in consumption while junk and sugary drinks should be minimal.Notwithstanding, the best source of information for a pregnant woman is her doctor who has her medical history, and should always be carried along before any extra information is implemented by her.

Credit: The Guardian

Erectile Dysfunction and Infertility

Erectile Dysfunction and Infertility

Dr. Abayomi Ajayi

01-4667360, 07026277855 info@nordicalagos.org

When a man cannot attain or maintain an erection suitably for sexual intercourse, it is usually an inconvenience, particularly if he and his partner are trying to conceive. Erectile Dysfunction, also known as impotence, is a form of sexual dysfunction that is present in about 20 to 25 per cent of infertile couples. It can cause infertility or even worsen it when diagnosed.

Erectile Dysfunction is an inability to get an erection that is good enough to achieve intercourse. The severity of erectile dysfunction can vary from complete lack of erection, to a partial erection that is not enough for penetration or is lost soon after penetration. Although ED is typically more common among older men, it can occur at any age.

Sexual impotence has psychological roots with anxiety, depression and stress. Sexual arousal depends on an intricate interplay of psychological, neural, vascular, and endocrine factors. Hormonal imbalance can also lead to ED. The inability to achieve pregnancy could be due to sperm production that is below par or due to poor sperm motility. Both impotence and infertility have a negative impact on intimate relationships, quality of life and self-esteem.

Erectile Dysfunction can be treated at any age; however, the occurrence is increasingly common with ageing, but should not be considered a natural part of ageing. In older men, there may be physical or medical conditions that contribute to ED, including a variety of diseases, physical injury or side effects from prescription medications. Psychological factors and certain life choices such as smoking, obesity, stress, anxiety, guilt and fear of poor sexual performance can all contribute to ED.

When ED is physical, the tendency is there to have weak erections during masturbation or decreased frequency of morning erections. Men may be at higher risk for cardiac issues if their ED medication gradually stops working or if the ED has been a problem for a number of years. Presence of other cardiac risk factors such as diabetes, obesity or high cholesterol is helpful for diagnosis.

While the risk factors are typically associated with older men, ED is often the only cardiac risk factor in younger men and can be devastating to men regardless of their age and so should always be taken seriously. It helps to understand how an erection works. Sexual stimulation delivers extra blood to the penis through the arteries, causing an erection.

For an erection to occur, a specific sequence of events needs to take place, allowing blood to enter the penis while restricting the outflow of blood. The pressure created by this “trapped” blood is what maintains an erection.

If there is a consistent breakdown in any steps in the sequence, ED is the result.

Adequate sexual function is not essential for success of fertility treatments, but more importantly, any form of sexual dysfunction such as ED can be a source of stress and conflict in a couple’s relationship. The problem of ED can be worsened by performance anxiety and other concerns related to the need to achieve conception.

Many people believe that being impotent means they are infertile. However, impotence and infertility mean different things. While impotence is not a cause for infertility, it can make conception extremely difficult.

There is connection between infertility and sexual intercourse, however, there is no scientific evidence supporting a claim that some sexual positions are more likely to increase sexual ability and lead to conception. Some positions, such as missionary, may deliver the sperm closest to the cervix, but whether this increases the chances of getting pregnant has not been proved. Timing intercourse properly during ovulation is more important than focusing on the position when trying to get pregnant.

Basically, when it comes to getting pregnant, having intercourse more often is not necessarily going to increase the chances of conceiving. Women are fertile only five to 10 days during their monthly cycle – just before and during ovulation. Having intercourse on other times during the monthly cycle will not lead to pregnancy.

In addition, having sex several times per week can actually lower sperm count and decrease the chances of getting pregnant. To increase the chances of getting pregnant, a couple should have sex few days before ovulation and then on the day of ovulation, and limit sexual activity other times during this fertile time period. Thankfully, there are a number of things that can be done to resolve this problem.

As men age, testosterone (male sex hormone) levels drop to very low levels. In fact, about 25 to 30 per cent of men in their 50s may have low levels. If fertility is a concern, addition of testosterone can further lower a sperm count which may already be lower than normal. ED is linked to cardiovascular disease and men with ED demonstrate increased calcium in the blood vessels of the heart at a younger age.

Diagnosis includes evaluating medical and psychological history, performing a physical evaluation and conducting a series of laboratory tests. These tests include blood counts, lipid profiles and testosterone measurements. A psychosocial evaluation is used to examine possible psychological factors.

About half of all infertile couples suffer from one or more compromised factors in the male partner, including ED.

For this reason, during the initial evaluation, the male partner will be tested for sperm production and health, including sperm count, motility and morphology; semen volume and viscosity, and white blood cell count. Physical abnormalities are also looked for.

Erectile dysfunction can be treated with medication, psychological therapy, or vacuum devices. Surgical implantation of an inflatable prosthesis is also an option. During this procedure, a device that simulates erection is used in pumping fluid from a reservoir into inflatable tubes in the penis.

No matter what type of ED a man suffers, the first step is to go to the doctor and the earlier, the better. ED can have a profound effect on relationships because the men must admit to their partner that they have a problem and have to seek help. If a man is unhealthy and has not exerted himself, sexual activity can be a risky exertion.

There are many ways to treat impotence. The first line of therapy consists of lifestyle changes. Sometimes, the cause may be a prescription drug, so a new medication may be necessary.

Infertility, on the other hand, could have hormonal roots or there could be structural deformations leading to lower sperm count or poor sperm motility. Fertility treatments with assisted conception techniques like In vitro fertilisation or IVF are the best bet.

Credit: Punch