Age-related fertility decline occurs in men too

There’s a common misconception that men retain their fertility potential for almost a lifetime. Nothing could be further from reality. Men suffer from a similar decline in fertility as much as their women counterparts.

The dual age-related fertility decline is a natural phenomenon, thus skewed blame of women in matters of fertility should be avoided.

The decline in fertility starts in the late thirties, and gets more pronounced from the forties. The overall sperm quality decreases as age advances. Older men will increasingly become incapable of fathering more children, or just contribute to age-related miscarriages and fetal abnormalities.

Men should make decisions in matters of reproduction early enough, balancing this with other competing interests like careers and personal development.

Your reproductive plans must take account of your current age. You may choose to bring forwards, rather than delay child bearing if creeping towards the fourth decade. This may not always conform to your overall ambitions, but must be factored in if you harbor an eventual interest in having a family.

Awareness of fertility decline must be coupled with a lifestyle that maintains optimal sperm quality. Smoking, chewing miraa and use of other recreational drugs are all very toxic to sperm quality. It doesn’t end there. Sedentary lifestyles leading to obesity and other illnesses like diabetes also contribute to declining fertility potential. You want to keep yourself in optimal health, and avoid preventable conditions that may accelerate the decline in your reproductive potential.

But we are living in an age where even the best laid plans may come to a cropper. So what if you get caught up with the humdrum of competing interests, and have to push back your plans for raising a family to the later decades?

Just like for women, men also have the option of fertility preservation. You could choose to freeze your sperms as a backup for later use, when conditions for starting a family are more favorable. Better still, you could freeze fertilized eggs (called embryos), if already in a stable relationship but not ready yet to start a family. Frozen sperms or embryos maintain their quality till eventual use. But there are costs and ethical dilemmas involved in such matters that you must be willing to contend with.

Remember even advances in assisted conception techniques cannot fully compensate for age-related fertility decline. Aim to seek help early if conception does not occur within six months whilst in the advanced age group. Don’t send your female partner alone to a fertility clinic, you should always accompany her as you may be the one with a problem. It doesn’t matter if you have fathered a child before, you must accept the natural fertility decline that comes with getting older.

Delayed conception requires a fertility evaluation

Dear doctor, We are a 32 year old couple, with infertility for the last five years. We don’t think anything is wrong with either of us. Should we wait longer or seek help?

Delayed conception isn’t an uncommon event. For most, it’s usually a transient phenomenon, with spontaneous conception occurring in the course of time. However, there should never be any hesitation to be evaluated, especially when the delay is more than one year. Older couples beyond the mid-thirties should be evaluated earlier, after around six months of trying to conceive.

Five years is too long for a young couple not to have conceived. In such cases, waiting longer isn’t advised. There should be an immediate evaluation for both the man and the woman. Going for a consult with your regular gynecologist is a good first step. But you could also choose to go straight to a specialized fertility clinic.

The initial fertility consult will include a comprehensive review of your reproductive and sexual function. Both of you should attend the consult together. Clues about what might be the problem can sometimes be quickly evident during the first consultation. However, most couples require testing for various reproductive functions before a definite diagnosis can be made. Recommendations about the best treatment options can only be made once a thorough evaluation has been completed.

Most men only need to do a sperm test. If this turns out normal, additional testing isn’t usually necessary. Some men will however require more extensive testing if their sperm result is abnormal. Women often require several tests that include a check of the reproductive hormones, and imaging studies to assess the normality of reproductive organs. It may also be necessary to do additional specialized tests in women depending on what appears to be apparent.

Once your evaluation becomes conclusive, you will be advised on the most appropriate fertility treatment. Some will only require relevant advice and simple treatments. But those with complex fertility problems will likely require equally complex fertility treatments. Such treatments are quite demanding, and tend to be expensive. Success rates aren’t guaranteed either, some couples require repeated treatments before eventually conceiving.

In the face of delayed conception, seeking helper sooner than later is the most practical thing to do. The stigma around infertility can sometimes hinder couples to act appropriately. This shouldn’t ever be the case. Infertility should always be viewed as a disease, like any other disease. Couples must be cautious about anecdotal treatments that don’t really work. Consulting the right specialist should be the norm. Once a comprehensive evaluation has been done, a specific diagnosis usually leads to successful conception for most couples.

Male factor in infertility cases on rise

First-time father Paul Mwanjala (not his real name) dubs the birth of his baby girl last month “a miracle”. He and his wife had waited seven years before successfully conceiving their first child via in vitro fertilization (IVF).

The gynecologist found nothing wrong with Mrs Mwanjala, who is in her late 30s. But Mr mwanjala, who is in his early 40s, was dealt a hard blow. Tests found very few sperms in his semen, a condition known as oligospermia.

Men with this condition make up about 10 to 15 per cent of the total number of male infertility cases globally, said Dr Alfred Murage, of MyGyno Limited.

“The diagnosis was a shock. We stopped trying for a baby for over a year to discuss our next step. I tried alternative therapy such as traditional African and Chinese medicine but that did not work out,” said Mr Mwanjala, who works in the financial industry.

Mr Mwanjala’s case is not unique. Doctors say they are seeing more men with poor sperm quality, which is either the main or contributing cause of couples struggling to conceive.

Fertility experts have noted that data from global studies has shown that the proportion of couples with male fertility issues in developing nations has risen from about 30 to 40 per cent of infertility cases in the past decade.

The 10-year-long that surveyed 1,000 men from north India found that lifestyle factors like tight clothing, hot tub dips and long visits to the sauna, intensive gardening and farming resulting in pesticide exposure and increased obesity rates were major causes for the ever decreasing sperm count.

In Kenya, Dr. Murage, who focuses on Assisted Reproductive Technology (ART), sees about 30 male patients each month. They form about half of all infertility cases he sees at his clinic.

Studies have shown that majority of men who were exposed to high temperature at their workplace — welders, dyers, blast furnace workers and those employed in cement and steel factories — were more prone to infertility.

This is because the additional environmental heat increases the temperature of the scrotum, causing a negative effect on sperm production.

With more couples waiting longer before starting a family, age might be one culprit for flagging fertility.

Prof Mabisik a fertility specialist observed: “The ‘sell-by date’ is later for men than women, but male fertility declines with age too. In women, it starts to go down from the age of 35. For men, the decline starts from the age of 45.”

Lifestyle factors and poorer health, such as having a chronic disease at a younger age, may also reduce fertility.

What is prostatitis?

The prostate is a small organ located at the base of the bladder and wrapped around the urethra, the tube that empties the bladder through the penis. It sits in front of the rectum, and the back portion of the organ can be felt during rectal examination by a health care practitioner.

The prostate's purpose is to help with the male reproductive system. It makes up to 70% of the fluid that is ejaculated during intercourse, mixing its secretions with the sperm that are made in the testicles. The prostate also contracts at the time of ejaculation to prevent retrograde (or backward) flow of semen into the bladder.

Because of its location, the symptoms of any prostate problem tend to be associated with the bladder and can include urgency to urinate, frequency of urination, burning with urination (dysuria), poor urine flow, or inability to begin a urine stream.

Prostatitis is the general term used to describe prostate inflammation (-itis). Because the term is so general, it does not adequately describe the range of abnormalities that can be associated with prostate inflammation. Therefore, four types of prostatitis are recognized.

What are the types and symptoms of prostatitis?

There are four types of prostatitis: acute bacterial prostatitis;

chronic bacterial prostatitis

Acute bacterial prostatitis is an infection of the prostate that is often caused by some of the same bacteria that cause bladder infections. These include E. coli, Klebsiella, and Proteus. While it may be acquired as a sexually transmitted disease, the infection can also spread to the prostate through the blood stream, directly from an adjacent organ, or as a complication of prostate biopsy.Patients with acute bacterial prostatitis present with signs of an infection and may have: fever, chills, and shakes.Commonly there is urgency and frequency of urination and dysuria (painful or difficult urination).

Chronic prostatitis without infection, also known as chronic pelvic pain syndrome, is a condition where there is recurrent pelvic, testicle, or rectal pain without evidence of bladder infection. There may be difficulties with painful urination or ejaculation, and erectile dysfunction. The cause of chronic prostatitis without infection is not clearly understood.

How is prostatitis diagnosed?

After taking a history, the health care practitioner will likely have a directed physical examination concentrating on the scrotum, looking for inflammation of the testicle(s) or epididymis, and the flank and mid-back, where the kidney is located. If a rectal examination is performed, the prostate may be swollen and boggy, consistent with acute inflammation.

The most important laboratory test is a urinalysis to help differentiate the types of prostatitis.

A blood test called PSA (prostate surface antigen) may be elevated in chronic prostatitis. While PSA is used as a prostate cancer screening tool, it can also be elevated whenever the prostate is inflamed.

What is the treatment for prostatitis?

Treatment depends on the type of prostatitis. For example treatment for acute bacterial prostatitis is a prescription for antibiotics by mouth, usually ciprofloxacin (Cipro) or tetracycline (Achromycin). Home care includes drinking plenty of fluids, medications for pain control, and rest.

The demise of men in sex and reproduction

Sex and reproduction, as we know it today, may become a thing of the past. Science is already advanced enough to negate sex as a means of reproduction. And men’s contribution is the easiest to discount, slowly making men irrelevant.

Scientific breakthroughs have resulted in creation of sperms and eggs in the laboratory, using cells called stem cells.Such cells have the potential to develop into diverse specialized cells like nerves, blood cells or even eggs and sperms. Stem cells can be harvested from fertilized eggs (called embryos), from the umbilical cord after birth and also from organs like the bone marrow. Once harvested, stem cells can then be externally signaled to develop into either eggs or sperms.

Recent scientific research has created life from skin cells! Following successful creation of sperms from stem cells, scientists from Japan re-programmed skin-like cells into becoming eggs. The eggs were matured, fertilized with sperms and then implanted into a potential mother. This then resulted into healthy and fertile offspring, who went on to have offspring of their own. But hang on, this was not done in humans, but in mice!

The ultimate aim of such scientific research is to help infertile couples have children. If the same methods could be used in humans, then cells in skin could be turned into eggs and sperms. Any resulting child would be genetically related to the mother. Such scientific developments take a long time to translate into human use. The understanding of human development is still limited, and there are many ethical hurdles. Many questions remain unanswered about the long-term consequences on the health of any resulting child.

So how does this translate into making men irrelevant in sex and reproduction? Women are capable of carrying a pregnancy, while men are not. If a woman desires a pregnancy, all she would do is get some skin cells developed into sperms. These could be from a friend or a relative. She would then get the sperms inseminated in her, using the already growing eggs in her own ovaries, or even get some eggs developed from her skin.No need then to have a man around for the sake of conceiving!

So what will be the use of men? Such developments are way off from becoming commonplace in human fertility treatment. The expense and ethics of such treatments will make them only accessible to those with certain fertility problems. Sex will still have a place as the natural way of conception, and is unlikely to be completely replaced any time soon. And sex for pleasure will still make men desirable to their women counterparts, even though artificial sex gadgets already offer stiff competition in that respect as well!

So, the countdown to men’s irrelevance is still way off in the future, but it’s not science fiction either.