By Chioma Obinna
Mention “Infertility” and cold shivers run down peoples’ spines. Infertility threatens the love, peace and joy in a home. Many homes are faced with the agony of childlessness and infertility is fast becoming a plague. The desire of every couple is to become parents within the first or second year of marriage. While many couples have this dream fulfilled, quite a number of others do not; no matter how hard they try. When pregnancy is not achieved at a point, mistrust sets in. Most of the time, the woman bears the bulk of the blame.
Such was the case of Obigaeri and her childhood friend, Emeka, who later became her husband. “The moment I noticed my mother in-law’s frequent visits, I became suspicious,” Emeka said. Emeka and Obigaeri were close enough friends right from childhood that what started like child’s play blossomed into real life marriage.
Six years into the marriage, there was no sign of pregnancy not even a miscarriage. Tongues started wagging. Love in the home suddenly grew sour. Like the usual practice in Africa, the woman is blamed. Obiagaeri became a laughing stock before her husband’s family.
No one saw any good in her anymore. Obiagaeri’s world came crashing down. Month after month, she continued to wallow in self pity, hoping for a miracle. One day she ran into an old school mate, and they got talking. She narrated her story, and her school mate counselled and encouraged her to insist that her husband also go for a medical check up. But like the typical Nigerian woman, Obiageri was afraid to confront her husband.
While praying to God to open her womb, Obiageri had been to two in-vitro fertility, IVF, centres where she was given a clean bill of health. Six months later, when she could no longer bear the harassments by family members, she finally opened up: “I told my husband that it was time for him to also check himself”. But the response she received from Emeka shocked her. “Why should you involve me in that?”, he queried. His reaction was typical of African men.
However, his reaction did not deter Obigaeri. She mounted pressure until he gave in after several months. He finally agreed to go for screening. They went to another fertility centre in Lagos where it was discovered he was azoospermic, that is, had zero sperm count.
“The battle did not stop there. My husband argued that it was a lie, and that we needed a second opinion which we obtained from another clinic. The results came out the same.”
Then the search for solution began. It took a while before they decided to try IVF is the process by which eggs are removed from a woman’s ovaries and mixed with sperm in a laboratory culture dish. Fertilisation takes place in the dish, “in-vitro”, which means “in glass”. Thousands of IVF babies have been born since the first one emerged in 1978.
“And God decided to answer us. Today I am a living testimony. I have a set of twins, a boy and a girl.”
Infertility remains a growing problem in Nigeria and the world at large. Reports have shown that 30 percent of men suffer infertility. Unfortunately, in this part of the world, women are presumed to suffer infertility and not men.
Emeka and Obiageri, after fertility experts told them there was chance they could have their own child, took steps to resolve the challenge. Different options were presented to them. They were told they could go for sperm donation or Intracytoplasmic Sperm Injection (ICSC) among others. Convincing Emeka on the options was another challenge. Emeka, vehemently rejected the option of sperm donation. Few months later, there was a drama in the neighbourhood. Life, you may say, sometimes may be unfair . While Emeka likes children, few years after marriage he has not been able to have children of his own.
Meanwhile, he was fond of his neighbour’s children. One fateful afternoon, he was playing with the children in front of his house, when one of them fell and broke his arm. Emeka tried to help the child. From nowhere, the parents of the child came out, and, instead of finding out what happened, they lashed at Emeka. “Is it our fault that you have no children? Why do you want to kill our child? If you love children so much what stopped you from having yours?”, they said. Emeka broke down in tears and left.
Emeka’s case is just one out of the many experiences of many couples with the problem of infertility in their neighbourhoods. This incident, however, motivated Emeka. “My husband came back home and suggested we immediately resume treatment. That is how our problem was solved”, Obiageri said. One of the IVF clinics was able to help them, and they are now proud parents of Jane and Juliet. According to them, they approached their challenge after Emeka realised there was hope. Emeka and Obiageri were helped with ICSI as part of IVF treatment to conceive.
ICSI, according to experts, is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments. The procedure requires just one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to the woman’s uterus (womb). In ICSI, as with standard IVF treatment, the woman will be given fertility drugs to stimulate her ovaries to develop several mature eggs for fertilisation. When the eggs are ready for collection, the woman and her spouse will undergo separate procedures.
The husband may produce a sperm sample himself by ejaculating into a cup on the same day as the wife’s eggs are collected. If there is no sperm in his semen, doctors can extract sperm from him under local anaesthetic. The woman’s doctor will use a fine needle to take the sperm from the husband’s epididymis, in a procedure known as percutaneous epididymal sperm aspiration (PESA), or testicle, in a procedure known as testicular sperm aspiraction (TESA)
If these techniques don’t remove enough sperm, the doctor will try another tactic. He’ll take a biopsy of testicular tissue, which sometimes has sperm attached. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is carried out with a microscope. After giving the woman a local anaesthetic, the doctor will remove her eggs using a fine, hollow needle. An ultrasound helps the doctor to locate the eggs. The embryologist then isolates individual sperm in the lab and injects them into the woman’s individual eggs. Two days later the fertilised eggs become balls of cells called embryos.
The procedure then follows the same steps as in IVF. The doctor transplants one or two embryos into the woman’s uterus through her cervix using a thin catheter. If you are under 40, you can have one or two embryos transferred. If you are 40 or over, you can have a maximum of three embryos transferred if using your own eggs, or two if you’re using donor eggs. Extra embryos, if there are any, may be frozen in case this cycle is not successful.
One cycle of ICSI takes between four weeks and six weeks to complete. You and your spouse can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You’ll go back anywhere between two days and six days later for the embryo transfer procedure.
The success rates for ICSI are higher than if you use conventional IVF methods. A lot depends on your particular fertility problem and your age. The younger you are, the healthier your eggs usually are, and the higher your chances of success. The percentage of cycles using ICSI, which result in a live birth, is over 35 per cent if you are under 35. ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you. ICSI doesn’t appear to affect how children conceived via the procedure develop mentally or physically. ICSI restored happiness in Emeka and Obiageri’s marriage.
According to experts, infertility is inability to conceive or produce offspring despite having regular unprotected sex. Infertility occurs when a poor reproductive system impairs the ability of the body to perform necessary functions of reproduction, and affects nearly 25 percent of couples in Nigeria. Experts claim that 40 to 45 percent of all consultations in gynaecological clinics are infertility-related.
Although, there have been several cases of male infertility and approximately 30 percent of infertility attributable to male factors, in many cases, it appears that men are not as willing or as able as their female partners to talk about their experience. When a man is involved, in countries like Nigeria, it is treated in secret. A school of thought believes it could be due to the fact that, traditionally, children are seen as a woman’s province, or because, over the ages, conception has been thought of as the woman’s responsibility.
‘Why men suffer infertility’
But the Medical Director (MD), Nordica Fertility Centre, Lagos, Abuja and Asaba, Dr. Abayomi Ajayi, says men contribute a lot to the challenge of fertility as findings have shown that, every year, there is 30 percent decline in sperm count. Ajayi, a consultant obstetrician and gynaecologist, maintained that although there are many factors, sperm count appears to be decreasing worldwide and no one knows why it is so.
“We don’t know why ‘but that is what we have seen. We have substantiated that in Nordica by comparing the sperm of people who presented 10 years ago to the sperm count of people who are presenting now. It is obvious to us that there had been about 30 percent decline. It is like, every year, there is 30 percent decline in sperm parameter. There is no doubt that sperm is a big issue all over the world.”
The MD, who, however, said there is hope for even men without sperm in IVF treatment, explained that technology has made it possible for men with as low as 40,000 sperm count to have children instead of the average sperm count of 15 million. According to him, one of the advantages of ICSI is that the sperm doesn’t have to travel to the egg or penetrate the outer layers of the egg and this process can help couples where the man’s sperm can’t get to the egg at all. It can also be recommended when sperm can get to the egg, but, for some reasons, can’t fertilise it. ICSI is likely to be recommended if your spouse has a very low or zero sperm count. It can also be recommended when you have a high percentage of abnormally shaped sperm and can result in poor motility, which means the sperm can’t swim well.
Quality of sperm
Ajayi pointed out that one out of every four Nigerian couples will experience delay in getting pregnancy, saying that if 100 couples have intercourse at once, only about 20 percent will conceive. He stressed, that a man’s fertility generally, relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and, sometimes, impossible for him to cause pregnancy. Studies have shown that infertility is a widespread problem. For about one in every five infertile couples, the problem lies solely in the male partner.
It is also estimated that one in every 20 men has some kind of fertility problem with low numbers of sperm in his ejaculate. However, only about one in every 100 men has no sperm in his ejaculate.
Causes of male infertility
Another consultant gynaecologist, Dr. Victor Ajayi, said: “Male infertility is usually caused by problems that affect either sperm production or sperm transport. About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are made do not work properly.
“Sperm transport problems are found in about one in every five infertile men, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen”. For known causes of male infertility, experts have also identified sperm production problem, chromosomal or genetic causes, undescended testes, infections, varicocele (varicose veins of the testes), medicines and chemical, and radiation damage.
‘Why couples should be evaluated’
Victor Ajayi stressed the need to always evaluate both parties in cases of infertility. “Current studies have shown that, after 45 years, a man begins to have issues with sperm. At that age, a man may experience two heads and two tales sperm. We encourage DNA in old men. Some may have their DNA damaged and there will be problems such as having difficulties impregnating their women, or damage babies,”he said. The consultant gynaecologist noted that semen is not the same thing as sperm, saying sperm cannot be seen with naked eyes as it lives within the semen.
Things that can dispose men to infertility
On things that can dispose men to infertility, Ajayi listed them to include complications of sexually transmitted diseases, STDs, such as Chlamydl; trauma alcohol ingestion, which, according to him, can slow down sperm; marijuana; cocaine ingestions; drugs for body building, tight pants; and cigarette smoking.
He warned that long-distance travelling drivers could suffer infertility due to their sitting position which is usually close to the engine of their vehicles. However, with increasing rates of infertility among couples, health watchers are of the view that couples, after a few years of trial, should seek help as there are many advanced procedures that can diagnose and treat infertility in both men and women. Studies and experiences have shown that infertility is no longer a problem for women alone; it should be the concern of all.