|Year : 2016 | Volume
| Issue : 2 | Page : 86-91
Seminal fluid features of male partners of infertility patients in southeast Nigeria
Leonard O Ajah1, Benjamin C Ozumba1, Robinson C Onoh2, Paul O Ezeonu2, Chukwuemeka A Iyoke3, Ijeoma V Ezeome3
1 Department of Obstetricsand Gynaecology, Federal Teaching Hospital, Abakaliki; Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus, Enugu, Nigeria
2 Department of Obstetricsand Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria
3 Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus, Enugu, Nigeria
|Date of Web Publication||13-Jan-2017|
Leonard O Ajah
Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus, Nsukka
Source of Support: None, Conflict of Interest: None
Background: Semen analysis has remained an objective, inexpensive and readily available means of assessing male factor infertility. There is a paucity of studies on male factor infertility in Nigeria using the current World Health Organization 2010 human values for semen characteristics. Aim: This study was aimed at determining the socio-demographic and semen characteristics of the male partners of infertile couples in Abakaliki. Materials and Methods: The case files of infertility cases managed at Federal Teaching Hospital from January 2011 to December 2015 were retrieved. Results: Out of 730 semen analysis results analysed, 297 (40.7%) have abnormal parameters ranging from abnormal motility (36.7%), to the combination of low sperm count, abnormal motility and morphology (0.68%). While older age and urban dwelling had significant effect on abnormal sperm motility, rural dwelling and low/or no educational status had a significant effect on low seminal fluid volume and sperm count (P-value ≤ 0.05). Conclusion: There is still a high rate of male factor infertility in this environment.
Keywords: Abakaliki, infertile couples, male partners, seminal fluid analysis, WHO 2010 reference values
|How to cite this article:|
Ajah LO, Ozumba BC, Onoh RC, Ezeonu PO, Iyoke CA, Ezeome IV. Seminal fluid features of male partners of infertility patients in southeast Nigeria. Afr J Med Health Sci 2016;15:86-91
|How to cite this URL:|
Ajah LO, Ozumba BC, Onoh RC, Ezeonu PO, Iyoke CA, Ezeome IV. Seminal fluid features of male partners of infertility patients in southeast Nigeria. Afr J Med Health Sci [serial online] 2016 [cited 2017 Aug 21];15:86-91. Available from: http://www.ajmhs.org/text.asp?2016/15/2/86/198320
| Introduction|| |
Infertility is a global problem that causes a major psychological burden. It is a complex disorder with significant medical, psychosocial and economic impact. Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. The global infertility rate affects between 8 and 12% of all couples. However, it appears to be worse in Africa as infertility rates among couples in African countries range from 15 to 30%. In a country, where much importance is attached to procreation as evidenced by low contraceptive prevalence and high total fertility rate, infertility accounts for the commonest reason for gynaecological consultation in Nigeria.,, It has previously been reported that about 30% of infertility is due to female factor, 30% to male factor, and 30% to combined male/female factors while in 10% of cases, there is no identifiable cause.
Infertility constitutes 15.4% of gynaecological out-patient cases in Abakaliki, Ebonyi State. There is a high misconception in which the male partners of infertile women in Abakaliki claim to be healthy and not being responsible for infertility. Therefore, semen analysis has remained an objective means of assessing male factor infertility. It is inexpensive, and the facilities are readily available in most infertility clinics. It is usually among the early investigations requested for in the evaluation of infertile couples. The World Health Organization (WHO) defined normal values for semen analysis as complete liquefaction within 60 min at room temperature, homogenous, gray, and opalescent appearance, seminal volume of greater than or equal to 1.5 ml, and a pH greater than or equal to 7.2. Other parameters comprise concentration of greater than or equal to 15 million sperm cells per millilitre, total sperm number of 39 million per ejaculate, motility of 32% or more with forward progression, and a morphology of 4% or more normal forms. The WHO 2010 semen parameters differ from WHO 1999 criteria as described in the table below:,
There are paucity of studies on male factor infertility in Nigeria that used the current WHO human values for semen characteristics as most of the previous studies on this subject matter in Nigeria used the old (WHO 1999) normal seminal fluid parameters. There was no previous study that used the current (WHO 2010) seminal fluid parameters in Ebonyi State in particular. More so, the socio-demographic peculiarity of Ebonyi State underscores the need for this study. It was because of these reasons that this study was embarked upon. It was aimed at determining the socio-demographic characteristics and semen characteristics of the male partners of infertile couples in Abakaliki, Ebonyi State.
| Materials and Methods|| |
Abakaliki is the capital of Ebonyi State. Ebonyi State is a mainland south-eastern state of Nigeria and has an estimated population of 4.3 million according to the 2006 national census. It occupies a land mass of 5935 km2. Approximately 75% of the population of Ebonyi State dwell in rural areas with farming as the major occupation. Urban Abakaliki consists of two local government areas, namely Abakaliki and Ebonyi, out of 13 local government areas in Ebonyi State. The Federal Teaching Hospital (FETHA) is a tertiary hospital located in Abakaliki metropolis. The hospital was formed in 2011 from the merger between the former Ebonyi State University Teaching Hospital and the then Federal Medical Centre, Abakaliki. The hospital gets referrals from within Ebonyi State and the neighbouring states of Enugu, Abia, Imo, Cross River and Benue. The hospital runs gynaecological clinic, gynaecological emergency and family planning clinics from Monday to Friday.
This was a retrospective study in which case files of all the infertility cases that were managed at FETHA from January 2011 to December 2015 were retrieved. Usually at the study centre, the WHO standard is used in the collection, processing and culture of the samples. A pro forma was used to collate information on the socio-demographic characteristics of the clients and the seminal fluid parameters. All the case files with complete seminal fluid analysis results were included for the study while the files without the seminal fluid analysis results or with incomplete seminal fluid analysis results were excluded. For the purpose of this study, the following terms were used, and their meanings were stated in the table below:
Statistical analysis was done using the Statistical Package for the Social Sciences version 17 software (SPSS Inc., Chicago, IL, USA). The analysis of variance and Student’s t-test were appropriate and were used for the analysis of the continuous variables while the Pearson chi-squared test was used to analyse the categorical variables. A P-value of less than or equal to 0.05 was considered statistically significant.
| Results|| |
A total of 748 case files on infertility were retrieved. However, it was only 730 (97.6%) case files with complete seminal fluid analysis results that were analysed. The mean age of the male partners was 38.81 ± 6.02 years, and their ages ranged from 25 to 59 years. [Table 1] shows the socio-demographic characteristics of the men. Majority of the patients were younger than 45 years (81.7%), urban dwellers (58.2%), had primary and secondary education (80%) and were farmers (29.2%). [Table 2] contains the comparison of the normal and abnormal seminal fluid parameters. There was a statistical significant difference between the normal seminal fluid parameters and the abnormal ones.
Summary of the seminal fluid parameters is contained in [Table 3]. Though 433 (59.3%) of the male partners of infertile couples have normozoospermia, the rest have abnormal seminal fluid parameters ranging from asthenozoospermia, 268 (36.7%) to oligoasthenoteratozoospermia [oat syndrome], 5 (0.68%). [Table 4] contains the relationship between socio-demographic characteristics of the male partners and seminal fluid parameters. Older age has a statistical significant effect on asthenozoospermia. More so, rural dwelling has a statistically significant effect on hypospermia and oligozoospermia. However, asthenozoospermia was significantly found more among the urban dwellers. Occupation of the male partners did not have any statistically significant effect on the seminal fluid parameters. Hypospermia was significantly found among the male partners with lower and/or no educational qualification. [Table 5] contains the organisms isolated from seminal fluid culture. Staphylococcus aureus and Candida albicans were the most common and the least common organisms isolated, respectively.
|Table 4 The relationship between the socio-demographic characteristics of the male partners and seminal fluid parameters|
Click here to view
| Discussion|| |
This study was aimed at determining the socio-demographic characteristics and semen characteristics of the male partners of infertile couples in Abakaliki, Ebonyi State. Most of the research questions were answered by the results. The male factor infertility accounting for 40.7% in this study was similar to 42.4% previously reported in Nnewi. This was, however, higher than 16.7, 26.1, 30 and 31.8% reported in Sokoto, Enugu, Ife and Abeokuta, respectively.,,, It was also higher than 8–12, 8–9, 30 and 9.4% reported from East and Central Europe, Australia, the United Kingdom and the United States of America (USA), respectively.,,, The male factor infertility reported in this study was lower than 69.1 and 83.7% reported from Lagos and a rural mission hospital in Ebonyi State, respectively., With the exception of the report from Enugu, Abeokuta, and Ife,,, the discrepancies in seminal fluid parameters between this study and the other reports may be due to the different WHO reference values used in calculating the seminal fluid parameters. While the Enugu, Abeokuta, Ife and this study used the current (WHO 2010) reference values for seminal fluid parameters, some of the remaining studies used the old (WHO 1999) reference values., The other studies such as the reports on male infertility from USA and Australia were interview-based surveys.,
Similar to the previous report in Ife and Lagos,, there was no case of aspermia among the male partners of infertile couples in this study. This was, however, contrary to a previous report from a rural mission hospital in Ebonyi State where a whopping 12.3% of the male partners had aspermia. Though, aspermia is commonly believed to be due to the obstruction of the genital tract from genital tract infection in this environment, there may also be other contributory factors such as retrograde ejaculation and androgen insensitivity. Hypospermia accounting for 23.7% in this study was much higher than 12.6% reported in Abeokuta. It has been adduced that hypospermia causes infertility by impairing the sperm biochemical interactions and motility. The proportion (7.8%) of the male partners who had azoospermia in this study was similar to 8% reported from Abeokuta, but higher than 2.6% was previously reported in rural mission hospital in Ebonyi State. More so, this is lower than 11.3% reported from Sokoto.
The number of male partners (32.1%) who had oligozoospermia in this study was slightly higher than that reported in Abeokuta, southwest Nigeria (28%). Similarly, the asthenozoospermia of 36.7% in this study is higher than 25% reported in Abeokuta. However, the combined seminal fluid defects such as oligoteratozoospermia (3.4%), oligoasthenozoospermia (9.6%), asthenoteratozoospermia (1.8%) and oat syndrome (0.68%) are lower than similar defects reported in Abeokuta. This study showed that the majority of both normal and abnormal seminal fluid parameters occurred among the male partners between 35 and 44 years might have been because this age group constituted majority of this study population. The male partners (34.1%) who had a positive culture in this study is similar to 34.6% reported by Emokpae and his co-authors in Kano. This is, however, less than 75 and 77% previously reported in Ife and rural mission hospital in Ebonyi State., This study showed that hypospermia and oligozoospermia are significantly more common among rural dwellers, and less educated/uneducated men are supported by the previous studies which showed that male factor infertility was more common among low socio-economic individuals. More so, asthenozoospermia being significantly more common among older men, and urban dwellers is supported by a previous report by Harris et al., which showed that infertility was more associated with aging population. Because the urban dwellers are more prone to sedentary life style when compared with the rural dwellers, this may have accounted for asthenozoospermia being more common among the urban dwellers.
S. aureus, being the commonest organism isolated among the clients with positive culture in this study, is similar to other studies in this environment.,,, The high infection rate, especially with S. aureus, could either be due to penile contamination or true infection. The significant association between the genital tract infection and seminal fluid abnormalities has previously been established in Nigeria., On the basis of this association, Emokpae and his co-authors advocated for treatment of all the genital tract infections including S. aureus.
Though seminal fluid analysis is the cornerstone in the investigation of male partners of infertile couples, it has been shown to be ineffective in reliably predicting the fertility status of men. There is an inherent variability in semen parameters among men. The WHO seminal fluid parameters lack the capacity to show the spermatozoa that have the inherent quality to achieve conception. This may be responsible for the reason why some men with normal semen parameters cannot impregnate their spouses while some others with mild abnormal semen parameters do so. However, some authors believe that male factor infertility can be detected from seminal fluid analysis with the combination of low sperm count, low progressive sperm motility and an abnormal sperm morphology. This study was a hospital-based retrospective type in which its findings may not be a true reflection of what was happening in the society.
In conclusion, there is still a high rate of male factor infertility in this environment using the current WHO reference values. This underscores the need for evaluation of male partners in every infertility work up. The male partners with treatable seminal fluid abnormalities should be treated while those with complex abnormalities should be referred for assisted reproductive technology.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab 2004;18:153-65.
Olooto WE, Amballi AA, Banjo TA. A review of female infertility; important etiological factors and management. J Microbiol Biotechnol Res 2012;2:379-85.
Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K et al.
The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod 2009;24:2683-7.
Inhorn MC. Global infertility and the globalization of new reproductive technologies: Illustrations from Egypt. Soc Sci Med 2003;56:1837-51.
Umeora OU, Mbazor JO, Okpere EE. Tubal factor infertility in Benin City, Nigeria − Sociodemographics of patients and aetiopathogenic factors. Trop Doct 2007;37:92-4.
National Population Commission (NPC) [Nigeria], ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria and Rockville, MD, USA: NPC and ICF International; 2014.
Orhue A, Aziken M. Experience with a comprehensive university hospital-based infertility program in Nigeria. Int J Gynaecol Obstet 2008;101:11-5.
Obuna JA, Ndukwe EO, Ugboma HA, Ejikeme BN, Ugboma EW. Clinical presentation of infertility in an outpatient clinic of a resource poor setting, South-East Nigeria. Int J Trop Dis Health 2012;2:123-31.
WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th
ed. Geneva, Switzerland: WHO Press, World Health Organization; 2010. p. 7-113.
WHO Laboratory Manual for the Examination of Human Semen and Sperm Cervical Mucus Interaction. 4th
ed. Cambridge: Cambridge University Press; 1999.
Ezegwui H, Onoh R, Ikeako L, Onyebuchi A, Umeora O, Ezeonu P et al.
Investigating maternal mortality in a public teaching hospital, Abakaliki, Ebonyi State, Nigeria. Ann Med Health Sci Res 2013;3:75-80.
Ikechebelu JI, Adinma JI, Orie EF, Ikegwuonu SO. High prevalence of male infertility in southeastern Nigeria. J Obstet Gynaecol 2003;23:657-9.
Panti AA, Sununu YT. The profile of infertility in a teaching Hospital in North West Nigeria. Sahel Med J 2014;17:7-11.
Menuba IE, Ugwu EO, Obi SN, Lawani LO, Onwuka CI. Clinical management and therapeutic outcome of infertile couples in southeast Nigeria. Ther Clin Risk Manag 2014;10:763-8. doi: 10.2147/TCRM. S68726.
Owolabi AT, Fasubaa OB, Ogunniyi SO. Semen quality of male partners of infertile couples in Ile-Ife, Nigeria. Niger J Clin Pract 2013;16:37-40.
Chukwunyere CF, Awonuga DO, Ogo CN, Nwadike V, Chukwunyere KE. Patterns of seminal fluid analysis in male partners of infertile couples attending gynaecology clinic at Federal Medical Centre, Abeokuta. Niger J Med 2015;24:131-6.
Bablok L, Dziadecki W, Szymusik I, Wolczynski S, Kurzawa R, Pawelczyk L et al.
Patterns of infertility in Poland − Multicenter study. Neuro Endocrinol Lett 2011;32:799-804.
Collins HP, Kalisch D. The Health of Australia’s Males. Canberra: Australian Institute of Health and Welfare; 2011.
Human Fertilisation and Embryology Authority. Fertility Treatment in 2010–Trends and Figures London. HFEA, United Kingdom; 2010. Available from: http://www.hfea.gov.uk./docs/2011-11-16
. [Accessed on 2016 Apr 22].
Mandong BM. Histological pattern of testicular biopsies in Nigerian men (undergoing investigations for infertility in Jos, Nigeria). Highl Med Res J 2002;1:7-8.
Akinola OI, Fabamwo AO, Rabiu KA, Akinoso OA. Semen quality in male partners of infertile couples in Lagos Nigeria. Int J Trop Med 2010;5:37-9.
Ugboma HA, Obuna JA, Ugboma EW. Pattern of seminal fluid analysis among infertile couples in a secondary health facility in South-Eastern Nigeria. Res Obstet Gynecol 2012;1:15-8.
Martinez G, Daniels K, Chandra A. Fertility of men and women aged 15–44 years in the United States: National Survey of Family Growth, 2006–2010. Natl Health Stat Rep 2012;51:1-28.
Ibekwe PC, Mbazor JO. Semen evaluation of infertile couples in Abakaliki, Nigeria. Ebonyi Med J 2002;1:33-7.
Nieschlag E, Behre H. Andrology: Male Reproductive Health and Dysfunction. Springer Science & Business Media, New York; 2013. p. 54. ISBN 978-3-662-04491-9.
Okon KO, Nwaogwu M, Zailani SO, Chama C. Pattern of seminal fluid indices among infertile male partners attending the infertility clinic of University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Highl Med Res J 2005;3:18-23.
Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. J Hum Reprod Sci 2015;8:191-6.
Harris ID, Fronczak C, Roth L, Meacham RB. Fertility and the aging male. Rev Urol 2011;13:e184-90.
Emokpae MA, Uadia PO, Sadiq NM. Contribution of bacterial infection to male infertility in Nigerians. Online J Health Allied Sci 2009;8:6.
Ugboaja JO, Monago EN, Obiechina NJ. Pattern of semen fluid abnormalities in male partners of infertile couples in southeastern, Nigeria. Niger J Med 2010;19:286-8.
Wang C, Swerdloff RS. Limitations of semen analysis as a test of male fertility and anticipated needs from newer tests. Fertil Steril 2014;102:1502-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]