Introduction
Poverty
in Sub-saharan Africa can be described as being endemic. Unfortunately, this
problem is associated with ignorance, illiteracy, poor hygiene, high prevalence
of communicable diseases and generally, components of reproductive ill - health
including sexually transmitted diseases. Sexually transmitted diseases account
for a significant proportion of the causes of obstructive uropathy.
Male
factor Sub-fertility is probably in the region of 40 – 50% despite the
reluctance to appreciate and accept same
Causes of Male Sub-fertility
- Ineffective
coitus (5%) (Mostly mechanical causes)
with normal sperm function
i.e.
those with normal ejaculation – Erectile dysfunction hypospadia
-
retrograde ejaculation – Bladder neck Surgery, DM,
Phenothiazines
-
Ejaculatory failure – anorgasmia, spinal cord injury.
- Azospermia
(5%)
Pretesticular:
- Steroids, Kalman’s Syndrome e.t.c.
Non
– Obstructive: - Cryptorchism, orchitis, 47XXY, radiotherapy and
Chemotherapy
Obstructive:
- vasectomy, epididymorchitis, Chlamydia and G.C.
- Sperm
autoimmunity (5%): Antisperm
Antibodies, Genital infection and Idio- pathic
4. Semen abnormality (85%): idiopathic, drug, genetic,
varicoele.
(Sperm dysfunction)
5. Sperm abnormality (<1%): Immotile cilia (Katagener
Syndrome)
Treatment of Male Infertility
Treatable Causes: - Treat the cause
Idiopathic causes (>50%)
of cases
Hormones - GnRh / HmG
- Recombinant FSH
- Exogenous Testosterone
- Anti Oestrogens
Non – hormonal therapies
-
Kallikrein
- Antioxidants
- Vit E
- Bromocriptine
Non –
treatable causes
Management:
- If fertility cannot be achieved by other treatments,
ART offers possibilities for symptomatic treatment of male infertility
(Oligospermia, Azospermia, Globozospermia, and Ashthenozoospermia.e.t.c.
ART methods used in the treatment
of Male Infertility
- Artificial
Insemination with partner’s sperm (I.U.I)
- Conventional
IVF
- High
Insemination Concentration IVF
- Microdrop
IVF
- Sperm
motility stimulants
- Zonal
Drilling
7. Partial Zonal Dissection
- Sub-zonal
insemination
- Intracytoplasmic
Sperm injection (I.C.S.I)
The
most successful albeit expensive and commonly used of these procedures is I.C.S.I
Indications for ICSI
- Previous
failed I.V.F. attempt.
- Marked
depression of semen parameters/ poor quality sperm
-
Sperm Concentration < 5 million / ml
-
Progressive motility
< 10%
-
Normal morphology < 4%
-
Total motile sperm count after sperm preparation < 1
million
- Borderline
semen parameters
- Specific
patient groups like the following:-
-
Patients suffering with retrograde ejaculation
-
impotence necessitating electroejaculation
-
severe antisperm antibody problem
- poor quality thawed sperm (e.g. from
testicular cancer patients)
- Sperm
retrieved from patients with initial diagnosis of azospermia.
- In
– vitro matured Oocyte (I.V.M)
At the HVC, our ICSI rate in the
previous 12- months is 68%, mostly for abnormal sperm parameters. Poverty
in my view is a social disorder which makes it very difficult if not impossible
for patients to afford the cost of ART. For instance, the case of one of our
most recent recipient of “The Hope valley Clinic
Faith Award” is worth mentioning.
The
HVC “Faith Award” is given to a couple who in the Judges opinion is
considered to be the most consistent, enduring, hopeful and faithful in terms
of number of previous IVF/ ICSI attempts prior to a successful one. By
implication, it is considered to be financially burdensome for most couples to
afford the cost of IVF/ICSI. It is even more so when they are confronted with
the possibility of having to undergo more than one attempt.
On
the corollary, the depressed state of our economy and the huge cost involved in
setting up an assisted reproductive centre has led to paucity in the
availability of such services in the past. At the last count, during our very
successful NFS/ IFFS International Conference in Lagos, we were intimated with
figures of just about 13 IVF centers in West Africa, most of them in Nigeria. This
is nothing compared by any standard to about 83 centres in the UK, more than
75% of them in London and Surburbs.
I
therefore implore us to pay purposeful attention to possible remedies that tend
to make ART more affordable.
Possible remedies:
- Improvement
in standard of living
- Improved
health education at all levels with emphasis on reproductive health.
- Increased
health sector funding by Government.
- Increased
activity of N.G.O in all the above.
- Sustained
activities of ART centers in creating awareness about availabilities of
remedies for male factor subfertility
- Continuing
collaboration between ART centers within and outside Nigeria, especially
with low cost of IVF in view.
- Continuing
specialist training in ART
- Political
stability vis-à-vis improved health sector planning and strategy.
Conclusion
I
have a dream that sometimes in the very near future, Africa shall be free from
the recurring bondage of high level of poverty, excruciating reproductive ill
health and persistent economic depression.
I
wish you all interesting deliberations.
Thank
you.
Dr. Michael Ogunkoya
Managing Director, The Hope Valley Fertility Clinic
+2348033069466
The Hope Valley Fertility Clinic
Plot 31, Block 113,
Gbemileke Akinsonwon Street, Opposite Treasure Garden, By Ikate Roundabout,
Lekki Phase 1, Lagos-Epe Express Way, Lagos.
+2348033069466
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