Causes of infertility in men

Anita Nabankema experienced the emotional distress that a man, who is incapable of fathering children, is subjected to.
“I was in an unhappy marriage for eight years. We tried everything to have a child; and in the beginning, many of our friends offered advice. But, nothing seemed to work.”

The advice was on the premise that Nabankema was the infertile one. No one advised the couple to seek medical opinion.
“I was the one who drunk the bitter herbal concoctions. I bore the brunt of my in-laws’ anger. When one of them had a baby, my mother-in-law demanded to know why I was denying her a chance to carry her son’s children.”

With the urging of his relatives, Nabankema’s husband entered relationships with different women, hoping to produce an heir. Unfortunately, none of them conceived.

“Gradually, it occurred to him that he could not father a child and naturally, he concluded that I had bewitched him. He turned violent. Every time he beat me, he told me to leave his home. I eventually left after bearing the beatings for two years.”
In another relationship now, Nabankema has two children.

What causes infertility in men?
According to the American Society of Reproductive Medicine, both men and women are each responsible for 30 percent of infertility, and the rest is attributable to unexplained reasons.

Dr Cohen Maliro of Reach Out Mbuya Parish HIV/Aids Initiative attributes male infertility to the quantity and quality of sperm.
“First, there is low sperm count. In an ejaculation, millions of sperms are produced, although only one fertilises the egg. In an infertile man, few sperms are produced, making the chances of fertilisation low.”

Internally, varicocele (varicose veins in the reproductive organs) could lower the number of sperms a man produces.
“Deformity within the reproductive system can lead to problems in the flow of seminal fluid,” Dr Maliro says, adding, “In such cases, sperms are produced without tails to enable them to swim towards the egg. They die before reaching the egg.”

He adds that some men do not ejaculate because the tubes inside the reproductive system are blocked. Untreated infections from sexually transmitted diseases, which cause scars inside the tubes, can block the transportation of sperms or even their production. Also, trauma from serious injuries to the genitals can cause blockages.

Psychological and emotional effects
Experts believe that a man’s self-esteem is tied to his sexuality. In our cultural setting, the idea that a genetic line must be continued is very strong.

Ali Male, a counselling psychologist, says an infertile man develops a guilty conscience. “He feels bad because he cannot fulfil his obligation to make his wife pregnant. Some men develop negative ways of coping with this guilt.”

A man confronting infertility will get depressed and anxious. Feelings of inadequacy crop up, deeply affecting his potency. Some men withdraw from sexual activity. Feelings of impotence will lead to inner questions about his masculinity. With time, this stress begins to show.

“A man who cannot father children has a deep fear of meeting his in-laws because he feels small in their presence,” Male says, continuing, “He may avoid functions where relatives and friends are celebrating their children’s achievements.”

The pent-up feelings also manifest in verbal anger and other forms of violence towards their partners. As a result, the marriage suffers. Some men blindly attribute the problem to their wives, and pursue extramarital affairs to prove their masculinity and desirability.

Medical treatment for infertility
A couple that cannot conceive should visit qualified medical personnel, such as gynecologists or urologists, who can prescribe the necessary treatment. Some causes of infertility, if diagnosed early, can be treated.

“If the infections in the reproductive organs are not severe, they can be treated with antibiotics,” Dr Maliro says, adding that this treatment is only effective if the condition has not caused scaring in the tubes through which the seminal fluid passes. In such cases, surgery would be the most viable solution.