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Saturday, April 13, 2024

The denial of male infertility in our society

Male infertility is an issue that decreases the chances of a male getting a female pregnant. This means that despite trying, the couple is unable to have a baby. Globally, in one of 5 infertility cases, the issue is with the man. Even in Pakistan, 21.9 % of the male population suffers from infertility issues. Unfortunately, the stats for infertility are increasing every decade.

Fertility has traditionally been associated with the female partner’s reproductive capacities but the world over now male factor infertility is an established fact. Menopause was considered to be a term specific for females but now men in the western world are acknowledging the effects of declining hormones on their physical, emotional and mental health. According to a recent publication in America, 16 percent of men below 40 years of age have coital problems just as women were long known to have premature menopause.

I recently had an interaction with a couple seeking infertility treatment and I was so touched by the story told by the lady that I decided to share some facts. The couple got married fifteen years ago, the girl was 20 years of age and the guy was 30 at that time.

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The old norms of Pakistan

It is a norm in Pakistan that exactly nine months after a couple’s marriage, all elderly female members from both sides of the family start asking about “The good news”. It was no different for this couple. So, the lady asked her husband that probably they should start getting investigated. The husband as usual was not willing to get his investigations done as he considered himself fit and well. The lady got her ultrasound done, hormones and tubes checked and kept on trying for pregnancy but conception was never achieved. Now, 15 years later the couple desperately wants a baby but both husband and wife have multiple adverse factors in their histories. Guy has diabetes which has effected his sperm production as well as the ability to perform coitus. The lady at 35 years of age has got premature ovarian failure.

If this couple would have started investigations earlier, their story could have been different. The reports might have confirmed at that time that mild male factor could be covered by performing an IUI or even IVF could have been possible.

There are many other examples where women alone keep visiting the fertility clinics because men are either so proud of their masculinity or do not want their adverse reports to come to the surface. Sometimes, the women’s eggs have to be frozen because the husband never comes in time to provide his sperm. Although marriage wows bind couples to mutual love, respect and understanding but most of the time women alone are filling up the void from another side.

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World over, 30 to 40 percent of infertility is associated with male factors

Pakistan is no exception. Reasons can be manifold including sub optimal management of diabetes, high cholesterol levels, obesity, spinal cord injuries, nerve disorders, heavy smoking, alcoholism etc. Furthermore there is one hidden enemy, Klinefelter syndrome 47XXY.

Klinefelter syndrome happens as a result of a random error of cell multiplication when the early baby is being formed. The baby receives one extra X chromosome. Such individuals are males, May or may not have problems at puberty or with coitus but they hardly have any sperms, have low testosterone hormone, and low muscle mass. The person himself does not know his status unless investigation on hormone and chromosomes are done. Sadly, it is not very uncommon, 1 in 600 men can be Klinefelter.

Another commonly observed condition is the side effects of medicines used to treat depression and other Psychiatric conditions. The Wisest approach is to work on own health before entering into a relationship to avoid causing stress and frustration to another person’s life. Families of effected individuals should offer sincere help rather than arrange a wife in the hope of achieving improvement in their son’s condition.

Amazingly, there are some courageous men and women in Pakistan as well who are giving online consultations about Psychosexual counselling. Urban medical centres provide in person consultations with these counsellors who can help couples identify the problem areas and overcome the stress and difficulties of an amateur performer.

Recently, Instagram had a post saying that Punjab Govt is planning to offer infertility treatment centres at Govt hospitals. That would be a great help to couples facing serious fertility issues. Treatment of such cases is expensive and not everyone can afford to pay the cost. In western world there are criteria set by the govt whereby most deserving couples get funded by the state. I would further request the govt of Pakistan to make regulations to maintain sperm banks for healthy sperm donations to help couples with male factor infertility.

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How can infertility be treated?

In western world, there are established sperm banks, where men with healthy sperms donate their Sperms as charity. Those donors are tested first for infectious diseases and possibility of any inheritable disease is excluded. Then characteristics like skin colour, eye colour, height etc are matched with the couple seeking conception. Donor never meets the couple, instead legal advisors at the fertility clinics act as third party and legal documents are signed for the parenthood rights. The condition for such rights is that at least one person should be the biological parent. So, if problem is with sperms, donor sperms are injected into the woman’s womb either through the simple process of IUI or if the woman’s eggs or tubes are in question then IVF can be offered.

Women without a uterus can avail surrogacy. Surrogacy is a term in which another woman hosts the baby in her womb but sperms are used from the fertility seeking couple either through IUI or IVF. Again, legal forms are signed.

Coming back to the example of the couple who wasted 15 years of life in denial and now are visiting one after the other fertility clinic, couples should mutually look into their options earlier. Men also can have a list of investigations just like women, which includes ultrasound, hormone levels and chromosome analysis. Lifestyle changes, including regular daily exercise, healthy food, fruits and vegetables can replace smoking, alcohol can improve overall health.

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I hope this helps to bring clarity around the mist of male infertility.


The author has done MBBS, MCPS, FCPS, MCCEE, and is a consultant Obstetrician & Gynecologist at Mega Medical Complex. The views expressed in the article are the author’s own and do not necessarily reflect the editorial policy of Global Village Space.