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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 3-5

The pattern of male infertility in Kumasi, Ghana


1 Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
2 Department of Surgery, School of Medical Sciences, University of Cape Coast, Cape-Coast, Ghana
3 Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana

Date of Web Publication10-Sep-2018

Correspondence Address:
Patrick Opoku Manu Maison
School of Medical Sciences, University of Cape Coast, Cape-Coast
Ghana
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajiac.ajiac_3_18

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  Abstract 


Background: Male factor infertility is a global health issue that requires further studies to understand its magnitude, especially in developing countries, where the woman is usually blamed for the couple's infertility. Objectives: This study aimed to determine the patterns of male infertility in a teaching hospital in Ghana. Methodology: This was a prospective study of 110 male patients who presented with infertility at the urology outpatient clinic of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, from January 1, 2014, to December 31, 2017. Results: One hundred and ten men reported for the treatment of infertility over the study period. The mean age was 38.5 ± 7.4 years. The majority (58.2%) had primary infertility while the remaining 41.8% had secondary infertility. Four (3.6%) of the men had unilateral or bilateral cryptorchidism while 41 (38.7%) of those with both testes resident in the scrotum had small-sized testes. Varicoceles were present in 24 (22.6%) men, 58.3% of whom had primary infertility while the remaining 41.7% had secondary infertility. Thirty-eight (34.5%) of patients had low semen volume was seen in 38 (34.5%) patients. Azoospermia was seen in 28 (25.5%) patients with 30 (27.3%) patients having no motile spermatozoa. Conclusion: Male infertility in Ghana should receive more recognition, and male participation in reproductive health programs should be encouraged.

Keywords: Couple, factor, infertility, male


How to cite this article:
Gyasi-Sarpong CK, Manu Maison PO, Koranteng AK. The pattern of male infertility in Kumasi, Ghana. Afr J Infertil Assist Concept 2017;2:3-5

How to cite this URL:
Gyasi-Sarpong CK, Manu Maison PO, Koranteng AK. The pattern of male infertility in Kumasi, Ghana. Afr J Infertil Assist Concept [serial online] 2017 [cited 2018 Dec 11];2:3-5. Available from: http://www.afrijiac.org/text.asp?2017/2/1/3/241011




  Introduction Top


Male infertility is a global health issue that as yet, is not well researched or studied to truly understand its magnitude and prevalence.[1] The majority of couples with infertility are in developing countries where negative consequences of childlessness are experienced to a greater degree when compared with Western societies.[2] Male factor infertility is estimated to account for 20%–40% of infertility among couples in Sub-Saharan Africa.[3]

Although male factor infertility is estimated to account for 45% of infertility in Ghana, data on male infertility in Ghana are still scarce.[4]

This study was, therefore, designed to determine the patterns of male infertility in a teaching hospital in Ghana.


  Methodology Top


This was a prospective cross-sectional study involving male patients who presented with infertility at the Urology Outpatient Clinic of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, from January 1, 2014, to December 31, 2017. They were evaluated and followed up till December 31, 2017 when the study ended.

Only men with inability to impregnate their partners after 1 year of regular unprotected sexual intercourse were eligible for this study. Relevant data were obtained included age, marital status, occupation, duration of infertility, medical, surgical, sexual, family, social, and drug history. Physical examination for male body habitus and external genitalia for anomalies, such as hypospadias, cryptorchidism, varicoceles, etc., was performed by an urologist, and the findings were documented. All patients had semen analysis done at the laboratory of the KATH and those with severe oligospermia or azoospermia underwent hormonal assessment.

Data were collected with a Pro forma and entered into Microsoft Excel. Data analysis was done with PASW Statistics for Windows, Version 18.0. Chicago, SPSS Inc.

Ethical clearance for the study was obtained from the Committee on Human Research Publication and Ethics of the Kwame Nkrumah University of Science and Technology.


  Results Top


One hundred and ten men reported for the treatment of infertility over the study. The mean age was 38.5 ± 7.4 years with an age range of 24–63 years. This included 108 (98.2%) married men and 2 (1.8%) men who were cohabiting. The majority (58.2%) had primary infertility while the remaining 41.8% had secondary infertility. The duration of infertility among the men ranged from 1-20 years but the majority 79 (71.8%) of them had been suffering from infertility for 1-5 years as shown in [Table 1]. The majority 94 (85.5%) had partners who were considered fertile after gynecologic evaluation, and only 16 (14.5%) of these men had partners who also had female factor infertility.
Table 1: Sociodemographic characteristics

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Four (3.6%) of the men had unilateral or bilateral cryptorchidism. Forty-one (38.7%) of those with both testes resident in the scrotum had small-sized testes while 58.5% of them had abnormalities on palpation of the epididymis as shown in [Table 2]. Varicoceles were present in 24 (22.6%) men, 58.3% of whom had primary infertility while the remaining 41.7% had secondary infertility.
Table 2: Physical signs demonstrated on the patients

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The results of the seminal fluid analysis are as shown in [Table 3].
Table 3: Seminal fluid analysis for 110 men (n=110)

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The abnormality of semen volume was seen in 38 (34.5%) patients. Mild oligospermia was seen in 14 (12.7%) patients, and 30 (27.3%) patients had severe oligospermia. Azoospermia was seen in 28 (25.5%) patients. Disorder of sperm motility was seen in 90 (81.8%) patients with 30 (27.3%) patients having no motile spermatozoa.


  Discussion Top


Infertility is considered a stressful experience and a threatening crisis for couples in all cultures worldwide.[5] In the developing world like Ghana, nothing threatens the couples' relationship as infertility.[6]

In most developing countries, the woman usually carries the blame for the couple's inability to conceive despite the high prevalence of male factor infertility. Male factor only accounted for 85.5% of cases whereas male and female factors accounted for the remaining 14.5% of cases in this study. This is relatively high compared with the estimated 20%–40% male factor involvement in Sub-Sahara Africa or the 45% male factor previously recorded from Ghana.[3],[4] This is probably because this study was limited to either couples with infertility due to male factor only or couples with both male and female infertility and excludes couples with female factor only infertility.

Similar to observations in Southeastern Nigeria, the majority (58.2%) of men in this study suffered from primary infertility.[7] This, however, contrasts with the observation by Fiander A, that 40% of male patients in Ghana had primary infertility.[4]

Globally, men's apparent reluctance to access healthcare services is considered a key factor influencing gender differences in health,[8],[9] and it is presumed that men delay medical consultation and present with serious disease at a later stage.[10] More so, in sub-Saharan Africa, men typically did not report their infertility because of the associated stigma of being less masculine.[1] However, in spite of this tendency to delay help-seeking in relation to infertility, this study observed that the majority (76.4%) of men reported within 5 years of childlessness, similar to observations in Southeastern Nigeria by Ikechebelu et al.[7] Hence, the relative early presentation by the men in this study is commendable and may be due to increasing knowledge of the high prevalence of male factor infertility.

Varicoceles are estimated to be present in 40% of patients with primary infertility and 80% with secondary infertility.[11],[12] This is inconsistent with the findings from this study where the majority of men with varicoceles had primary infertility.

Abnormality of semen volume was seen in 38 (34.5%) patients. This was higher than the 7.3% reported in Enugu Eastern Nigeria.[13] Oligospermia, azoospermia, and asthenospermia were the most common semen parameter abnormalities observed in the study. Thirty (27.3%) of the males that had seminal analysis had no sperm motility, consistent with similar studies from Nigeria.[7],[14],[15]


  Conclusion Top


Male infertility in Ghana deserves more recognition as a public health problem. It is important to encourage male participation in reproductive health programs and research in Ghana and most Sub-Saharan African countries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol 2015;13:37.  Back to cited text no. 1
    
2.
Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update 2008;14:605-21.  Back to cited text no. 2
    
3.
Lunenfeld B, Van Steirteghem A, Bertarelli Foundation. Infertility in the third millennium: Implications for the individual, family and society: Condensed meeting report from the Bertarelli foundation's second global conference. Hum Reprod Update 2004;10:317-26.  Back to cited text no. 3
    
4.
Fiander A. Causes of infertility among 1000 patients in Ghana. Trop Doct 1990;20:137-8.  Back to cited text no. 4
    
5.
Covington SN, Hammer Burns L. Infertility Counseling: A Comprehensive Handbook for Clinicians. New York: Cambridge University Press; 2007.  Back to cited text no. 5
    
6.
Evens EM. A Global Perspective on Infertility: On Under Recognized Public Health Issue. Chapel Hill: University Center North Carolina; 2004.  Back to cited text no. 6
    
7.
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. 7
    
8.
Broom A, Tovey P. Men's Health: Body, Identity and Social Context. Chichester: Wiley-Blackwell; 2009.  Back to cited text no. 8
    
9.
Meryn S, Shabsigh R. Men's health: Past present and future. J Mens Health 2009;6:143-6.  Back to cited text no. 9
    
10.
Wang Y, Hunt K, Nazareth I, Freemantle N, Petersen I. Do men consult less than women? An analysis of routinely collected UK general practice data. BMJ Open 2013;3:e003320.  Back to cited text no. 10
    
11.
Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Epidemiology of varicocele. Asian J Androl 2016;18:179-81.  Back to cited text no. 11
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12.
Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril 1993;59:613-6.  Back to cited text no. 12
    
13.
Nwafia WC, Igweh JC, Udebuani IN. Semen analysis of infertile Igbo males in Enugu, Eastern Nigeria. Niger J Physiol Sci 2006;21:67-70.  Back to cited text no. 13
    
14.
Nwajiaku LA, Mbachu II, Ikeako L. Prevalence, clinical pattern and major causes of male infertility in Nnewi, South East Nigeria: A five year review. AFRIMEDIC J 2012;3:16-9.  Back to cited text no. 14
    
15.
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.  Back to cited text no. 15
[PUBMED]  [Full text]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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