The Standard Group Plc is a multi-media organization with investments in media platforms spanning newspaper print
operations, television, radio broadcasting, digital and online services. The Standard Group is recognized as a
leading multi-media house in Kenya with a key influence in matters of national and international interest.
June is Infertility Awareness Month. Fertility expert and president of Kenya Obstetrical and Gynaecological Society DR KIREKI OMANWA talks about ‘swimmers’, ‘matters plumbing’ and infertility in men.
How is it like treating couples grappling with infertility?
Doctors don’t look at what we do as ‘fun’ or ‘not fun’! We are focussed on helping patients recover and lead a normal life in society. To that extent, it is a satisfying job.
When infertility crops up, it is always the women getting blamed...
The data that has been collected so far shows that men are to blame for most of the infertility for which couples visit hospitals. Men alone account for approximately 40 per cent of infertility while women log in at between 30 and 35 per cent.
Do you get more male or female clients at your clinic?
Most of them are women. They come alone. My interpretation is that society still looks at infertility as a woman’s issue. Yet, men are equally culpable.
From your experience treating patients, men who cannot sire children in Kenya usually have what problem?
Men struggling with infertility commonly present with low sperm count (oligospermia) or lack of sperm altogether (Azoospermia). These conditions come about as a result of many factors.
How do diagnose the problem?
This is what we do at the clinic. First, we take the patient’s history. Then usually we will take the semen sample for testing. In the semen, we check for several things. One, we look at the volume – ideally a man should ejaculate at least 1.5ml of semen. We also look at its PH: it should be basic (PH 7.2 – 8). We then check for sperm presence and concentration. The ideal sperm concentration should be at least 15 million sperms per millilitre of semen. In one full ejaculation, at least 40 million sperms.
But if a man can ejaculate they don’t need to worry, right?
No. Semen is not the same as sperm. Semen contains seminal fluid and sperms. It nourishes sperms and is also medium for sperm to swim. Therefore, a man can have seminal fluid but no sperm.
What causes lack of sperms?
The cause could either be obstructive or non-obstructive. Obstructive would mean that the tubes through which sperms move from the testicles to the prostate gland are blocked. Blockage can occur because of a scar from previous surgery or from an infection – with diseases such as gonorrhoea, syphilis and chlamydia.
Non-obstructive azoospermia has been linked to hormonal imbalance issues. Hormones such as testosterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) are very critical to a man’s fertility. For instance, high LH and FSH levels would mean no production of sperm.
Apart from hormones, one could have suffered from disease mumps when they were a child. Mumps is a viral infection that destroys tissues responsible for sperm production in the testicles. Lastly, undescended testicles, that is testicles that never left the abdomen into the scrotum.
What about them?
When a baby boy is developing in the mother’s womb, their testicles develop in the abdominal cavity. Usually, the testicles will move from the abdomen into the scrotum. This is supposed to happen naturally. But in a few cases, the testicles fail to descend. Physiologically they are misplaced. They should be in the scrotum.
If the undescended testicles are brought down, would the man regain fertility?
When discovered in adulthood, nothing can be done to make the man fertile. It would be too late. However, when discovered early — like when the baby is a few months old — then the testicle can be salvaged and fertility at adulthood restored. This brings into focus the role of parents to their baby boys.
How can parents be of help?
When they are bathing baby boys, they should make it a habit to feel around the scrotum if testicles are present. They can palpate slowly. They ought to feel something the size of an orange seed. They check both testicles. Parents would also come in handy on mumps: vaccines are available for mumps and they should make sure the children are vaccinated on time.
I have heard about heat not being good for testes. Is that true?
Testicles are located in the scrotum where temperatures are 2 – 4 degrees lower than the body temperature. Higher temperatures prevent sperm production
Is there a physical symptom for azoospermia? You know, something like not being able to achieve an erection?
Not really. Remember, what a man ejaculates is a liquid that comes from the prostate. It can fail to have sperms. Not being able to produce sperms will not give you fever or anything like that so that you can say it is the symptom. You would actually have no symptoms.
Are there any other causes of infertility in men that you haven’t mentioned?
I started with the most common. But there are others. For instance, from available studies, we know that lifestyle habits such as smoking, alcoholism and drug abuse may lead to impotence. Illnesses such as erectile dysfunction make it hard for men to perform sexually so that they are able to make a woman pregnant. Accidents such as blunt force to the testicles can affect sperm production. Injury to the spinal cord – through which nerves between the brain and body organs pass – may also prevent a man from successful sexual intercourse.
Are there men who ejaculate air, like literally nothing?
It is possible but highly unlikely. A man will often ejaculate some liquid. But the liquid, like I said, may not have sperms. Some men also have retrograde ejaculation – where sperms move to the bladder instead of out through the urethra. And this may make it difficult for them to sire a child.
Do groundnuts help with fertility?
I have heard that too. These are myths that have not been proven beyond reasonable doubt. However, seeds and nuts are generally known to be rich in zinc and that is good for sperm production and sperm health.
Is infertility treatable?
In some cases, it is possible to give medication or perform surgery to rectify the damage. If a man is producing sperms and blockage is preventing sperms from moving into semen, then the blockage can be treated but it may as well be untreatable. We also have medication for low sperm counts. And if the problem is hormonal, there is a solution for that too. But it is not easy to make a man fertile when no sperm production is going on.
Do we have the expertise that can handle all these infertility issues in Kenya?
Yes. As Obstetricians, we are able to make the diagnosis and work with our urologist colleagues to design treatment options for men with infertility. You do not need to travel abroad to be treated.
join