Dubai: One in five couples in the UAE face infertility-related issues and in almost 50 per cent of the cases, men are the causative factor, according to a study of UAE males, both expatriates and Emiratis.
The issue of male infertility is, in fact, a worldwide issue as reported by several studies and the causes are mainly related to modern-day lifestyle matters such as obesity, diabetes, smoking and stress.
For example, as per the World Health Organisation (WHO) estimates in 2015, 60–80 million couples worldwide suffer from infertility.
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The study was conducted by the Bourn Hall Fertility Centre, Dubai, in the first quarter of 2017 on a sample of about 100 men across several nationalities between ages 25 and 56.
Dr David Robertson, medical director of the centre and a consultant in reproductive medicine and infertility, told Gulf News: “Our sample had a mix of British, North American, Indian, Pakistani, Filipinos, Arab expats [Jordanian, Syrian] and Emiratis, among others.”
The study’s conclusion: one in five couples in the UAE face infertility-related issues and in almost 50 per cent cases, men are the contributing factor.
In light of these findings, it’s important to first turn our attention to the issue of male infertility.
First, what causes this problem?
Defining male infertility, Dr Robertson explains that both a drop in the number of sperm and a deterioration in its quality contribute to infertility.
“Male infertility occurs when a man has a lesser sperm count than expected in a sample.” What’s the normal count? About 15 million sperms per ml sample, according to the World Health Organisation.
“Apart from the count per ml, another important factor is motility or movement of the sperms. They must be moving in a purposeful way,” says Dr Robertson, a UK-trained fertility specialist who leads medical and technical teams in Dubai and India.
“So, although both the count and the motility are important, the latter is more important. Even if the sperm count falls to 10 million per sample, it could work if the sperm motility is good.”
Stigma
Now comes the more tricky issue: with an increase in male infertility, how can the age-old stigma of women being considered the prime cause of infertility be addressed?
If a woman fails to conceive, she must not be blamed as the fault could, equally, lie with her husband.
Dr Robertson believes this viewpoint is slowly making way to fit in today’s reality.
“Back in the 1980s, if couples were unable to conceive, usually, the woman was blamed," he said, adding: "A man did not at all accept that he was in any way to be blamed.
"We still live in a fairly patriarchal world and no man likes to think that he has difficultly in fathering children. However, with access to more information, there is a gradual change in mindsets.
More men coming forward
"More men are coming forward to own up to their infertility problems. The very fact that we were able to get a high male infertility factor at our clinic goes to show that many men are coming forward to get their sperm count tested,” said Dr Robertson.
The study found that men in the UAE are quite aware of the ‘rights and wrongs’ of their reproductive health, potentially indicating a more tolerant and broad-minded approach towards the subject.
The study, focused on issues such as active and passive smoking, exercise and obesity, keeping laptops on laps for long hours, stress and the effect of tight underwear on sperm production.
“It’s interesting to note that on most counts, participants’ answers indicated that they understood the factors that could lead to infertility.”
He added: “We hope such studies will be instrumental in changing attitudes and behaviour of men towards the issue, since it shows that men are now willing to address their reproductive problems, instead of brushing them under the carpet.
"Such surveys will also help dispel myths surrounding men’s infertility. For example, we saw that an overwhelming 84 per cent agreed that when a couple is unable to conceive, the problem is not always with the female partner," said Dr Robertson.
"Similarly, 91 per cent of the participants understood the negative effects of passive and active smoking on fertility, even if it’s less than 10 cigarettes a day,” he added.
Loose underwear, keeping laptop on lap
The survey also revealed that men realised the significance of wearing looser underwear and pants (84 per cent said wearing tight underwear could lead to infertility issues) as well as the negative effects of working on a laptop while keeping it on one’s lap (72 per cent believe it can be harmful).
“The optimum temperature for sperm production has to be slightly cooler than our regular body temperature,” explained Dr David.
“And tight underwear can raise that temperature, resulting in poor sperm motility, leading to fewer or abnormal sperm production.
Similar is the case when resting heated laptop on one’s lap or exposing one’s self to heated Jacuzzi water for long and regular periods.”
Interestingly, the research found the opinion split over the impact of increasing age on fertility. More men (56 per cent) believe that a man’s age can negatively affect couple’s chances of fertility, while 44 per cent believe that it does not.
However, age is not a significant contributing factor in men, despite the fact that sperm quality can decrease with age, Dr Robertson pointed out.
Low sperm count
Dr Styliani Andronikou, chief embryologist at Dubai Health Authority’s Dubai Gynaecology and Fertility Centre (DGFC), said: “More than 90 per cent of male infertility cases are due to low sperm count, poor sperm motility, or abnormal morphology or combination of more than one of these. Morphological abnormalities (teratozoospermia) in particular accounts for a major part in male infertility.
The remaining cases [of male infertility] can be caused by a range of conditions including anatomical problems, hormonal imbalances (hypogonadism), and genetic defects (i.e. cystic fibrosis, Klinefelter’s syndrome).
A typical situation that can occur is when the first response to a prolonged inability to conceive children is to send the wife for assessment.
Nazima (name changed) and her husband S. A., had been trying to have children for nearly eight years.
Nazima was undergoing fertility treatments but was unable to conceive. Then, S.A., who had been sending his wife to the fertility clinic with his mother, was asked by the fertility expert to undergo tests which established that it was he who had a low sperm count.
Discrete treatment
He was put him on a discrete treatment protocol and in the second year of treatment, the couple were blessed with twins.
Like Nazima and S.A.,, many couples need to be helped to have a more comprehensive view of why their attempts at starting a family are not succeeding and what can be done to overcome the obstacle, advise experts.
Can male infertility be reversed?
Male infertility that is a direct result of bad lifestyle choices can be addressed and improved with a tweak in lifestyle opine fertility experts.
Dr Robertson said: “There are a number of studies looking at the impact of poor lifestyle choices on low sperm count. For men who are obese with a high low Basal Metabolic Rate, in a habit of eating junk food and suffering from poor blood sugar absorption and hypertension, a change in a lifestyle can really help. Even those who give up smoking cigarettes, shisha and alcohol can improve their sperm count. But for any lifestyle change to actually show one must follow it for a minimum of three months to have an improved quality of sperm as life cycle of sperm is three months.
What is the way forward?
According to Dr Robertson, in some cases of significant male factor infertility, IVF is the appropriate treatment option.
“From a preventive point of view and for detecting infertility issues sooner rather than later [through a simple semen analysis at any fertility clinic], education is required," said Dr Robertson.
Lifestyle
"The population as a whole needs to be made aware on factors affecting male infertility to create a long term change in culture and acceptance.
"Also, men need to understand that infertility is not a female condition, and in nearly 50 per cent of the cases we see, the issue is related to the man,” he said.
The Health Ministry believes strongly in public health awareness campaigns and starting health education in school from an early age to create awareness.
“If young men can be educated on how their lifestyle can impact their health in general, it will make them sensitive to the issue. For example, 1 in 4 people in this region suffer from diabetes, which also can affect fertility levels," Dr Robertson said.
"Education and early detection about healthy diet and physical activity from a young age could prevent many of these chronic conditions later in life,” he added.
