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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 35  |  Issue : 3  |  Page : 256-260

Semen profile of male partners of women attending infertility clinic in Zaria, Nigeria


Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Date of Web Publication11-Feb-2019

Correspondence Address:
Prof. Adebiyi Gbadebo Adesiyun
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TJOG.TJOG_18_18

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  Abstract 


Background: Semen analysis is an important investigation in the evaluation of male factor infertility. Diminishing semen profile has been widely reported mostly attributed to the environmental factor and lifestyle changes.
Methodology: A cross-sectional study of 154 male partners of women attending infertility clinic at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. The study was done between January and October 2011. The data were collected using questionnaires, semen analyses, semen cultures, and body mass index (BMI).
Results: The semen analyses done showed normozoospermia rate of 46.8% while 53.2% had abnormal semen profile. In this study, only 3.9% of the participants' semen that had significant round cells also cultured bacteria. There was no significant statistical association between the round cells count and bacteria culture. Bacteria growth was mainly staphylococcus aureus. There was also a significant statistical association between abnormal semen profile and the risk factors in male infertility, medication use, coital frequency per week, and positive semen culture for bacterial growth.
Conclusions: Proportion of participants with abnormal semen profile was high in this study. Significant round cell count did not translate to infected semen. There should be properly coordinated and heightened health education program on awareness and prevention of male infertility.

Keywords: Male infertility; round cells; semen analysis; semen culture.


How to cite this article:
Garba-Alkali AE, Adesiyun AG, Randawa AJ. Semen profile of male partners of women attending infertility clinic in Zaria, Nigeria. Trop J Obstet Gynaecol 2018;35:256-60

How to cite this URL:
Garba-Alkali AE, Adesiyun AG, Randawa AJ. Semen profile of male partners of women attending infertility clinic in Zaria, Nigeria. Trop J Obstet Gynaecol [serial online] 2018 [cited 2019 Apr 20];35:256-60. Available from: http://www.tjogonline.com/text.asp?2018/35/3/256/251939


  Introduction Top


It is estimated that about one in ten couples has difficulty in conceiving successfully. Infertility presents serious psychosocial problems to the affected couples and challenges to the attending gynecologist. Women suffer more than men as the causes are often attributed to them, especially in Africa. The etiological pattern of infertility in couples varies among different populations. In general, about 35% are caused by male factors and 35% by female factors while 20% are due to combined male and female factors, and in about 10% of the couples, the causes are unexplained.[1] Causes of male infertility generally result from endocrine disorders, anatomic disorders, abnormal spermatogenesis, abnormal motility, infection of genital tract, and sexual dysfunction.[2] Infections of the male genital tract are common causes of male infertility in Africa. Gonococcal, chlamydial, and coliform infections may cause semen profile abnormalities. Inflammatory damage may result in vas deferens or epididymal block with resultant severe oligozoospermia or azoospermia.[1],[2] Infertility may be prevalent among men with elevated body mass index (BMI). Forty percent of men presenting to an infertility clinic in a study in California, USA, were overweight.[3]

Semen analysis is one of the most important investigations used to evaluate the male partners of women presenting with infertility. The World Health Organization (WHO) reference values and criteria are widely used as a guide for normal parameters.[4] These have been reviewed four times since 1980, in 1987, 1992, 1999, and 2010 by the WHO.[4],[5],[6],[7] Males with good or reasonable fertility potential under in vivo condition are identified on the basis of semen quality. Furthermore, males with poor fertility potential are identified and introduced to treatment including assisted reproduction technology (ART). A fertile female may compensate for the fertility problem of the male, and thus, infertility usually only becomes manifest if both partners have reduced fertility. The prognostic factors for male infertility are duration of infertility, age, primary or secondary infertility, result of semen analysis, and fertility status of the female.[1],[4],[7],[8] There have been significant advances in ART, from artificial insemination, improved embryo culture media to intracytoplasmic sperm injection and preimplantation genetic diagnosis, which has resulted in remarkable increase in in vitro fertilization and embryo transfer pregnancy rates. Potent drugs are also now available for erectile dysfunction. These, in addition to the increasing public awareness and acceptance of ART, have spurred many couples in sub-Saharan African societies with infertility to seek medical care.[2],[9] This study evaluated the semen profile of the male partners of women attending infertility clinic. It also sought to know if significant round cell count in semen should be taken as an evidence of infection.


  Methodology Top


This was a cross-sectional study conducted from January to October, in the year 2011. The study population was made up of male partners of women attending infertility clinic that consented and presented their semen for analysis as part of investigation for infertility.

Inclusion criteria are first seminal fluid analysis, no prior treatment (medical or surgical) for infertility, semen fluid analysis, and culture done in the laboratory of the study setting, Ahmadu Bello University Teaching Hospital, Zaria.

Exclusion criteria are participants who did not consent or withdrew their consent, semen samples which method of collection did not comply with the instructions or contaminated sample, participants on antibiotics, or treatment for infertility. The WHO (1992) reference values and criteria were used as normal parameter guide for semen profile.


  Results Top


A total of 154 semen samples were analyzed, and the age of the clients was between 20 and 60 years. More than half 86 (55.9%) of the clients were within the age group of 31–40 years, followed by 34 (22%) in the age group of 41–50 years, then 28 (18.2%) in the age group of 20–30 years. The least age group in the study was 51–60 years with 6 (3.9%) clients. Hausa tribe constituted the major tribe in the study with 72 (46.7%) clients. Majority were civil servants 54 (35.0%) followed by lecturers/teachers 26 (16.9%). More than three quarters, 136 (88.3%) resided in urban centers. Almost two-thirds 94 (61.0%) of the clients had tertiary education. Majority 68 (44.2%) had a history of 1–3 years duration of infertility followed distantly by 7–9-year duration in 30 (19.5%) patients. The least duration of infertility was 4–6 years in 22 (14.3%) clients. The type of marriage in more than three quarters, 124 (80.5%) of the clients was monogamy while only 30 (19.5%) were practicing polygamy.

Almost two-thirds, 100 (64.9%) of the clients has had coital frequency of ≥3 times per week while the remaining had <3 times/week. About 44 (28.9%) had secondary infertility, and the remainder had primary infertility.

Past sexually transmitted diseases (STDs) constituted the major risk factor in 42 (27.3%) clients, followed by alcohol intake and urethral penile discharge 22 (14.3%), then cigarette smoking in 20 (13%) clients. Among the medications used are for the treatment of peptic ulcer disease which ranked highest 18 (11.7%), followed distantly by medication for HIV/AIDS in 8 (5.2%) clients. Majority of the clients 134 (87%) were not on chronic medication [Table 1].
Table 1: Cross tabulation of clinical variables and semen analysis (n=154)

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Majority of the clients 72 (46.8%) had normal semen analysis (normozoospermia), and 82 (53.2%) had abnormal semen profile. The breakdown of the types of abnormalities of semen profile seen in the 82 participants was asthenozoospermia 34 (41.5%), oligoasthenoteratozoospermia (OAT) 24 (29.3%), azoospermia 16 (19.5%), and the least abnormality was oligozoospermia 8 (9.7%). Aspermia was not seen [Figure 1]. Majority of the semen cultured did not grow any organism in 132 (85.7%) cases. Among the cultured organism, staphylococcus aureus was the most common in 14 (63.6%) cases [Table 2]. [Table 1] showed that there was a significant statistical association between abnormal semen analysis in relation to the risk factors, chronic medication, and coital frequency. On the contrary, there was no significant association in relation to duration of infertility, types of infertility and types of marriage. Normal BMI was in majority in 84 (54.5%) clients, followed distantly by overweight 46 (29.9%), then underweight and obese in 14 (9.1%) and 10 (6.5%) participants, respectively. The study showed no significant statistical association between normal semen analysis and abnormal semen analysis in relation to BMI [Table 3].
Figure 1: Distribution of abnormal semen analysis in male partners

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Table 2: Types of bacterial growth from semen culture (n=22)

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Table 3: Body mass index and semen analysis (n=154)

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About 24 (15.6%) of the client semen cultured grew organism while the rest, 130 (84.4%) did not grow any organism. There was no significant statistical association between the normal and abnormal semen analysis in relation to the semen culture [Table 4]. In the semen analysis, there were nonsignificant semen round cells (<5.0 × 106 ml) in 104 (67.5%) of the semen analyzed, while about 50 (32.5%) had significant semen round cells of >5.0 × 106 per ml. There was no significant statistical association among the participants with significant round cell count and bacteria growth [Table 5].
Table 4: Semen culture yield and semen analysis (n=154)

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Table 5: Significant semen round cell count versus bacterial growth (n=154)

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  Discussion Top


Semen analysis is the most widely used preliminary investigation to assess man fertility, and it is relatively easy to perform, affordable, and widely available. However, it is pertinent to note that the interpretation of semen analysis abnormalities serves at best as a guide. This is because fertility potential has not been found to be directly proportional to the gross appearance. In fact, there has been surprising fertility recorded in some men with the poor count, and wide variations are even obtainable in normal fertile men.[10]

The semen analysis was done in this study showed a normozoospermia rate of 46.8% while about 53.2% had abnormal semen profile. This is similar to reported rates of 29% to 42.4% for normozoospermia from other studies.[11],[12],[13],[14] However, in other series high rates of normozoospermia in the range of 62.7% and 78.4% was reported.[15],[16],[17] The abnormality of semen profile in this study is above average (53.2%). Among the abnormal semen profile, asthenozoospermia constitutes the most common with 22% followed by OAT (15.6%), azoospermia (10.4%), and oligozoospermia (5.2%). These rates and array of abnormalities are similar to the study findings from Ibadan, Southwest Nigeria [15] but in contrast to the findings of a study done in Jos, North Central Nigeria.[14] Treatment and more importantly preventive strategies are needed to be reappraised by the clinician and public health practitioner to reduce the problem. ART services at least in tertiary health facilities are vital in the treatment of some of these cases.

The finding that about 10.4% of the participants have azoospermia is worrisome as this rate is significantly high. The possible causes are STD, trauma, congenital problems such as cystic fibrosis and viral infection such as mumps among others. A related study showed the most common association between azoospermia and past illness of smallpox where out of 31 participants with history of smallpox, 15 showed complete azoospermia, and one showed sperm density of <10 million per mL.[18] Most participants in this category will require treatment by ART, most likely with donor sperm for them to achieve their dream of fatherhood. This is a challenge to the practice of ART, especially in settings where there is no regulation or law guiding the practice of ART, as cultural inclination and religious belief may be against some forms of ART treatment practices. The most common abnormality of asthenozoospermia has problem with motility, which is vital for fertilization process, while OAT has a combination of low sperm count, abnormal motility, and morphology. This group of patients may benefit from ART or intrauterine insemination (IUI) depending on the severity. Training and retraining of trainers and qualified trainees toward making IUI more accessible at most secondary and tertiary health institutions would help a long way.

In this study, about 3.9% of the client's semen that had significant semen round cell count also cultured bacteria. This proportion is small, and there was no significant statistical association between the semen round cell count and bacteria culture. This is a similar finding to the studies from Jos, Northwest Nigeria [14] and Ibadan, Southwest Nigeria.[19] The implication is that having significant semen round cells in semen microscopic analysis do not translate to the growth of an organism in the semen. This should be borne in mind when interpreting results by physicians that significant count of semen round cells does not singularly warrant antibiotic treatment for purported infection.

Bacteria growth in this study was 14.3%, mainly S. aureus (63.6%) followed distantly by  Escherichia More Details coli, Gardnerella vaginalis, and Klebsiella growth. This is in consonance with similar studies from the southern part of Nigeria.[19],[20] However, it is in contrast to the study result from Tunisia on semen culture and polymerase chain reaction assay; the prevalence of bacteriospermia in semen was 56.9% and the common bacteria species detected were Chlamydia trachomatis followed by Ureaplasma urealyticum and Mycoplasma hominis.[3] Contamination during collection and/or transportation of semen may not be totally ruled out in this study, more so with the growth of unusual organisms such as G. vaginalis and high yield of Staphylococcus. It is also pertinent to note that organisms implicated in the causation of low sperm count and abnormal sperm function (mainly sexually transmitted organisms) need special means of transportation and culture techniques, which were not applied in this study.

In this study, there were also a significant statistical association between abnormal semen profile in relation to the risk factors for infertility, medication use, and coital frequency per week. While there was no statistical significant difference in semen profile and the duration of infertility, types of marriage, and BMI. Infertility may be prevalent among men with elevated BMI. Forty percent of men presenting to an infertility clinic in a study in California, USA, were overweight.[3] However, the relationship between male obesity and other fertility parameters has not been well established. Decreased testosterone, sex hormone-binding globulin, and testosterone/estrogen ratios and inhibin B have all been documented among infertile obese compared with infertile nonobese men and fertile obese men.[21]

The findings that risk factors for infertility, drug use for diseases, higher coital frequency are more associated with abnormal semen profile are not unexpected since they are established risk factors of infertility. In a study of infertile African male at an andrology clinic in South Africa, 49% were secondarily infertile and 36% had previously received treatment for a urethral discharge. Varicoceles were present in 183 cases (11%) and 11% had serological evidence of previous exposure to syphilis.[22] On the contrary, most patients in this series had primary infertility.


  Conclusions Top


The rate of abnormal semen profile was high in the study. Most men that had their semen analyzed had primary infertility, and there was significant association between abnormal semen profile and known risk factors of male infertility, which are mainly preventable. These findings call for focused and heightened preventive strategies toward decreasing the occurrence of these risk factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Idrisa A, Ojiyi E, Tomfafi O, Kamara TB. Male contribution to infertility in Maiduguri, Nigeria. Trop J Obstet Gynaecol 2001;18:87-90.  Back to cited text no. 1
    
2.
Kumar A, Gadir S, Eskandari N, Decherney AH. Reproductive endocrinology and infertility. In: Current Diagnosis and Treatment in Obstetetrics and Gynecology. New York: McGraw-Hill; 2007. p. 917-36.  Back to cited text no. 2
    
3.
Oliva A, Spira A, Multigner L. Contribution of environmental factors to the risk of male infertility. Hum Reprod 2001;16:1768-76.  Back to cited text no. 3
    
4.
World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Semen-cervical Mucus Interaction. 5th ed. Cambridge: Cambridge University Press; 2010.  Back to cited text no. 4
    
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World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Semen-cervical Mucus Interaction. 2nd ed. Cambridge: Cambridge University Press; 1987.  Back to cited text no. 5
    
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World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Semen-cervical Mucus Interaction. 3rd ed. Cambridge: Cambridge University Press; 1992.  Back to cited text no. 6
    
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World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Semen-cervical Mucus Interaction. 4th ed. Cambridge: Cambridge University Press; 1999.  Back to cited text no. 7
    
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Idrisa A, Ojiyi E. Pattern of infertility in North Eastern-Nigeria Trop J Obstet Gynaecol 2000;17:27-9.  Back to cited text no. 8
    
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Cooke ID. Infertility. In: Edmonds K, editor. Dewhurst's Textbook of Obstetrics and Gynaecology for Postgraduates. 6th ed. Oxford: Blackwell Scientific Ltd.; 1999. p. 432-40.  Back to cited text no. 9
    
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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.  Back to cited text no. 10
    
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Salgado Jacobo MI, Tovar Rodríguez JM, Hernández Marín I, Ayala Ruiz AR. Frequency of altered male factor in an infertility clinic. Ginecol Obstet Mex 2003;71:233-7.  Back to cited text no. 11
    
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Ikechebelu JI, Adinma JI, Orie EF, Ikegwuonu SO. High prevalence of male infertility in Southeastern Nigeria. J Obstet Gynaecol 2003;23:657-9.  Back to cited text no. 12
    
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Ravolamanana Ralisata L, Randaoharison PG, Ralaiavy HA, Debry JM, Randrianjafisamindrakotroka NS. Etiologic approach in infertile couples in Mahajanga. Arch Inst Pasteur Madagascar 2001;67:68-73.  Back to cited text no. 13
    
14.
Imade GE, Sagay AS, Pam IC, Ujah IO, Daru PH. Semen quality in male partners of infertile couples in Jos-Nigeria. Trop J Obstet Gynaecol 2000;17:24-6.  Back to cited text no. 14
    
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Adeniji RA, Olayemi O, Okunlola MA, Aimakhu CO. Pattern of semen analysis of male partners of infertile couples at the university college hospital, Ibadan. West Afr J Med 2003;22:243-5.  Back to cited text no. 15
    
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Obiechina NJ, Okoye RN, Emelife EC. Seminal fluid indices of men attending infertility clinic at st. Charles borromeo hospital, Onitsha, Nigeria (1994-1998). Niger J Med 2002;11:20-2.  Back to cited text no. 16
    
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Giwa-Osagie OF, Ogunyemi D, Emuveyan EE, Akinla OA. Etiologic classification and sociomedical characteristics of infertility in 250 couples. Int J Fertil 1984;29:104-8.  Back to cited text no. 17
    
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Chowdhury TA, Habib F, Khanam ST. Male factors in infertility – A preliminary report. Bangladesh Med Res Counc Bull 1981;7:12-7.  Back to cited text no. 18
    
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Ogunbanjo BO, Osoba AO, Ochei J. Infective factors of male infertility among Nigerians. Afr J Med Med Sci 1989;18:35-8.  Back to cited text no. 19
    
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21.
Jarow JP, Kirkland J, Koritnik DR, Cefalu WT. Effect of obesity and fertility status on sex steroid levels in men. Urology 1993;42:171-4.  Back to cited text no. 21
    
22.
Bornman MS, Schulenburg GW, Boomker D, Chauke TR, Reif S. Observations in infertile African males at an andrology clinic in South Africa. Arch Androl 1994;33:101-4.  Back to cited text no. 22
    


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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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