Dr Irengbam Mohendra Singh
There’s always a prominent stamp of hopefulness in Manipur, even in the midst of political pandemonium, with larger-than-life dreams. Me included. I’ve always said there’ll always be a Manipur. With the fast falling culmination date of attainment of Nagaland Autonomy, perhaps this year, thanks to NSCN, all the indigenous people in Manipur, regardless of which tribe they belong to, should preferably be getting their identity track as Manipuris, especially the Nagas, to avoid the pitfalls of identity crisis.
The rapid unscheduled fall of semen count, I suspect Manipuris feel, is some obscure pearls of wisdom for the West to assimilate. It’s hardly. It’s not really an extended whine from the forever-busybody researchers from the West. And we in Manipur, may be part of the generation that leads to human extinction.
That was what researchers in July 2017, found out, though no significant decline was seen in Asia, Africa and South America. However, researchers cautioned that far fewer studies have been conducted in these regions. [That usually is the wont]. Scientists at the Hebrew University of Jerusalem, found that male sperm counts had fallen by almost 60% in 40 years, after analysing data from 43,000 men from North America, Europe, Australia, and new Zealand. They took in 185 studies from 1973 to 2011. They did not explore the reasons for the decline, apart from mentioning the usual association with life style and chemicals.
Though I take statistics with a pinch of salt, as the British Prime Minister Benjamin Disraeli once said: lies, damn lies and statistics, it’s always good to give the benefit of doubt to the these statistics, especially when researchers say it’s a wakeup call, like canaries in a coalmine. Researchers have been collecting statistics over the years. In 2007 a report published in the UK in the Journal of Andrology, found that in one UK city, sperm count had declined by 29% in 13 years between 1989 and 2002.
The Oakland Journal US, published in 2010, showed that average sperm count was falling from 113 million sperm/ml of semen in 1940 to 66 million/ml in 1990. The volume of a single ejaculate has declined from 3.40 ml (about a teaspoonful) to 2.75 ml (a flat teaspoon). Furthermore, the number of motile sperms has also dipped.A study in 2012, showed that more than 26,000 French men found their sperm counts fall by a third between 1989 and 2005. However, and importantly, the sperm count has not declined in the less polluted areas of the world during the same period.
Scientists are baffled at the cause of this decline. The erosion into human ability to procreate, being the anti-thesis of Darwinian evolution, I’m wondering whether the world would be populated by generations of IVF children, who would be going to the Moon to colonise, especially there is now a class of billionaire geeks with the wealth in the Silicon valley of America, to make it happen.
While scientists are looking for ways to stop the decline, let me refresh you with the old- fashioned basics of infertility ie a low sperm count of less than 2 million/ml, to begin with.
Around one in six couples have problems conceiving. The fault is distributed between male and female 50:50. Until a few years ago, infertility was in the domain of women. Still, South Asian wives, if they aren’t pregnant by the end of the first year of marriage, there would be grumblings in the family, with plans for the groom’s parents to get their son divorce her and marry another woman. I have known many such couples.
Men infertility is because of (1) too few sperms being produced; (2) too few swimming very actively; (3) altered shape and size of sperms; (4) no sperms produced at all. The situation can be caused by damage/injury to his testicles, underdeveloped testicles, or ejaculation disorders; and (5) varicocele (prominent veins) in the testes.
Varicocele is the most common disorder for male infertility, often with smaller testicular volume, producing less sperm population with impaired sperm quality. It’s found in 35% of men with primary infertility (infertile right from the start) and in 75-81% of men with secondary fertility (sometime in their life). Overall, varicocele is present in about 40% of men with infertility problems.
The stress of modern civilised living, work deadlines, and home commitments confuse the brain between psychological and physiological threat. So it releases more adrenaline (fight or flight response) that has a detrimental effect upon sperm production.
Sperms’ true love life never runs smooth. Competitions are hard. Out of about 400 million sperms in an ejaculate, only about 100 million get anywhere near a Fallopian Tube where the lovey-dovey egg is waiting to make love. Once released into the vagina, and even just outside, they have to be smart enough to swim up the vagina quickly so as to escape the lethal effect of vaginal acid (normal protective process against bacterial infection) that will kill them. They have to battle with the hostile cervical mucus and the woman’s immune protective system against foreign body.
They have to travel a long distance of 15 cm from the vagina into the cervix and then through the womb into the Fallopian Tube, taking between 45 minutes to 12 hours. In this marathon run, disabled and weakling sperms perish on the way. The egg guides them by sending chemical signals to find their way to her. Many will reach and bind to the egg, but only one suitor will be chosen for the final union between the lovers. This is how conception takes place. Naturally, the greater and healthier the number of sperms, the better is the chance of some of them reaching the egg, as many of them will fall by the wayside. With a low sperm count, chances of conception is from very minimal to naught.
The sticky point is why is the sperm count falling? If scientists know the cause they can fine treatment. At the moment, there is no great idea and so no specific treatment. A variety of lifestyle factors are blamed, such as stress, alcohol, smoking, obesity, anti-depressants and tight-fitting underpants. There is also some evidence that sunscreen creams and lotions containing endocrine-disrupting UV filters that Europeans use to prevent sunburn as the cause. Even non-stick frying pans that use poly- and perfluoroalkyl substances, oestrogen in our waterways from contraceptive pills and electromagnetic radiation from Wi-Fi routers may affect sperm counts. Recently, a study in this year (2018) and published in the Proceedings of the National Academy of Sciences provided evidence that “Ibuprofen” – a very popular pain killer/anti-inflammatory drug may be involved, if used for prolonged periods and in high dosage. It disrupts the production of male sex hormone testosterone. There are also concerns that chemical additives in food which are eaten everyday in the West, pesticides, industrial pollutants and water-based paints may be involved in producing low motile sperms that lack energy to swim.
Scientists are certain however, that genetics is not involved as the reported changes in infertility are occurring very quickly. Remedies can be found, such as reducing stress and changing in life styles, eating a better diet of raw fruit and vegetables. A good sleep might help.
Some gynaecologists blame women for their food and alcohol drinking habits during the first trimester ie 6 to 12 weeks of pregnancy. They say infertility in male starts before birth during this period when baby’s seminal organs are growing. Whatever the mother consumes in this period will affect the foetus. They cite incidences worldwide.
I’m sceptic of this statistics. One shouldn’t run for the hills just yet. The best thing to do is to father babies while a man is in his prime. The older the man the less is the sperm count.
In general, one-third of infertility cases are caused by male reproductive organs, one-third by female reproductive organs, and one-third by both male and female reproductive organs and the rest by unknown factors. According to the American Society for Reproductive medicine, Infertility is equally attributable to both the male and female partners.
Treatment of male infertility is still in its infancy as there has been less interest in it. It’s partly because infertility used to be defined in women when a couple cannot achieve pregnancy in a year. So, there has been more research on women infertility and many infertile women can happily become pregnant.
Infertility is suspected in both man and woman until it’s proved which one of them is at fault. Normally, 20% to 37% of young couples less than 30 years, can conceive in the first 3 month. On the negative side, studies suggest that 15% of couples are unable to conceive after 1 year, and 10% after 2 years.
Initially, a doctor should get the man’s sperm analysed first, when a couple report inability to conceive after at least a year. If normal, the doctor turns to the woman to find the cause that could be one of so many. In more than 80% of cases, the cause can be found. In 20% of cases, the cause is labelled unexplained or idiopathic. In many cases, when a cause can be identified it can be addressed with medical and surgical treatment with high success rate. (The writer is based in the UK Email:email@example.com Website: www.drimsingh.co.uk)
Dr Irengbam Mohendra Singh