Why men should openly discuss infertility issues

Roselyne Sachiti Features, Health & Society Editor
When a woman of childbearing age fails to conceive, it is easily visible as she does not fall pregnant.

There is so much pain and misery and guilt that surrounds women facing fertility challenges, yet since time immemorial, men too, have faced potency issues.

Culturally, barrenness was frowned upon, but society had a way of protecting men from the embarrassment of being labelled ngomwa (label of a person who cannot have children).

In the past, elders would take teenage boys to the river where they would test their fertility. By so doing, they had an idea of the potency of the young men whom they could easily help should they fail to sire children once married.

Zimbabwe National Practitioners’ Association President Sekuru Friday Chisanyu said culturally, before introduction of In Vitro Fertilisation (IVF), in cases where couples went for a long time without conceiving, the family comprising aunts and uncles would convene to find solutions and keep the family line alive.

“A woman stays for her children, so if she did not have any, she would easily leave the husband. Most families did not want to lose their daughters-in-law, whom they regarded as important.

“If they established that a man was infertile, the aunts and uncles would engage the couple. They would also identify a younger brother who has children and believed to be fertile to ‘help’ sire children. This was done consensually,” he said.

Chisanyu said the relationship between sister-in-law and brother-in-law was temporal and just for siring children. It was not expected to be emotional in any way.

In the event that children were sired, the infertile man would feel macho. Society believed he sired the children.

Some men even died without society even knowing that they were infertile.

“This was a well-kept secret among family elders as the whole idea was to save the marriage and prevent women from seeking seed outside,” said Sekuru Chisanyu.

There were other men, who because their families kept their infertility a secret to “protect” their egos, went to the grave without knowing their condition.

In the Bible, infertility is mentioned in many scriptures in which many couples who suffered from infertility: Abraham and Sarah, Isaac and Rebecca, Jacob and Rachel, Elkanah and Hannah, and Zachariah and Elizabeth come to mind. Several had to wait a long time for children.

Genesis 38 verses 8-9 also point out how the family line of an infertile couple would be protected.

“Then Judah said to Onan, “Sleep with your brother’s wife. Perform your duty as her brother-in-law and raise up offspring for your brother.

“9 But Onan knew that the offspring would not belong to him; so whenever he would sleep with his brother’s wife, he would spill his seed on the ground so that he would not produce offspring for his brother . . .”

This proves that infertility is not new to humankind.

Today, such practices no longer exist with modern methods of addressing infertility like IVF, surrogacy and adoption; e.t.c, coming in.

Yet, despite modern interventions, women still carry the burden of infertility as men’s lack of health-seeking behaviour keeps them in the dark. Most men still do not know they are infertile, yet their homes are “full” of children” they claim to be theirs.

For example, the majority of Zimbabwean men who challenged the paternity of children in 2015 discovered that they were raising other people’s children after DNA tests proved negative.

Statistics made available by the Harare Civil Courts in 2015 revealed that at least 72 percent of the men were exonerated from paternity by the tests, but not before forking out a lot of money in maintenance.

According to the World Health Organisation, 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.”

Issues ranging from genetics, environmental exposures and infectious diseases have been linked to infertility risk. Uterine fibroids, cysts, ectopic pregnancies among others have also resulted in women failing to conceive.

Family Health director in the Ministry of Health and Child Care Dr Bernard Madzima said in Zimbabwe, male infertility is mainly a result of sexually transmitted infections. He said chronic conditions like diabetes mellitus also cause male infertility.

Research studies show that around one in four men with type 2 diabetes have low testosterone levels (hypogonadism). Low testosterone levels can lead to problems which can reduce fertility such as low sperm count, erectile dysfunction and decreased sex drive.

“Other causes might be blocked passage of sperms, exposure to toxic chemicals like smoking, radiation, alcohol,” he said.

He added that cancer treatment can also damage sperm production.

Dr Madzima explained that the burden of infertility is borne by women largely.

“There is a general cultural belief that men are always fertile. This affects infertility evaluation and treatment as most men do not come for evaluation. The psychological impact is huge,” he revealed.

Dr Madzima added that the affected couples are stressed and sometimes depressed.

“Divorce is the usual end result. Also some end up engaging in extramarital affairs to ‘test themselves’ elsewhere. This puts them at risk of contracting sexually transmitted infections (STIs), which further worsens their infertility situation,” he explained.

According to the Urology Care Foundation: “About 13 out of 100 couples can’t get pregnant with unprotected sex. There are many causes for infertility in men and women. In over a third of infertility cases, the problem is with the man. This is most often due to problems with his sperm production or with sperm delivery.”

Urology Care Foundation notes that making mature, healthy sperm that can travel depends on many things.

“Problems can stop cells from growing into sperm. Problems can keep the sperm from reaching the egg. Even the temperature of the scrotum may affect fertility.”

One in every four couples in developing countries had been found to be affected by infertility, when an evaluation of responses from women in Demographic and Health Surveys from 1990 was completed in collaboration with WHO in 2004.

The problem remains huge.

In 2010, an estimated 48,5 million couples worldwide were unable to have a child after five years, according to a PLOS Journals report titled “National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys.”

It is clear that infertility should not be blamed on women only. Men, too, may be infertile, but without knowing it.

The name shaming that comes with infertility leaves women hiding in plain sight and suffering in silence.

In an effort to remove stigma associated with infertility, Merck Foundation through its “More than a Mother” campaign has been working with 15 First Ladies from various African countries appointed as ambassadors of the programme.

Merck More Than a Mother initiative aims to empower infertile women through access to information, education and health and by changing mindsets.

This powerful initiative supports governments in defining policies to enhance access to regulated, safe and effective fertility care.

“Merck more than a Mother” initiative will not only provide medical education and training for medical students and embryologists respectively, but it will also support Governments to define policies to improve access to safe and effective fertility care and address the need for interventions to reduce stigmatisation and social suffering of infertile women and the necessity for a team approach to family building among couples.”

According to the Merck Foundation website, “Merck more than a Mother” Advisory Board has defined five-year clear strategy and structured objectives.

These include creating a cultural shift to break the stigma around infertility and to respect and appreciate infertile women in Africa, Asia and developing countries.

Raising awareness about infertility prevention, management and male infertility through social media and media training programmes across Africa and Asia

Education and training for African fertility specialists and embryologists since the lack of trained and skilled staff is a major challenge

Building advocacy, open dialogue and work closely with government, policy, makers, parliaments, healthcare providers, fertility experts, media and art.

Empowering infertile women socially and economically through access to awareness, health and change of mindset.

Merck Foundation also encourages men to acknowledge and openly discuss their infertility issues and strive for a team approach to family building with their partners.

“A culture shift is needed to progress toward Shared Fertility Responsibility, although male factors contribute to about half of all cases of infertility, women are overwhelmingly perceived as being the party responsible for a couple’s infertility, and subsequently the social suffering associated with infertility tends to be greater for them than their husbands,” the foundation notes.

In Zimbabwe, “Merck More than a Mother” Ambassador, First Lady Amai Auxillia Mnangagwa, has already started engaging infertile couples and the Ministry of Health and Child Care to bring hope to the affected and also capacitate doctors.

The First Lady, through her ambassadorial role, is partnering the Ministry of Health and Child Care to address together the key challenges that are associated with resource-constrained settings such as prevention of infertility, education self-development, ART/IVF regulation, geographic barriers, and limited resources arguments.

Through the partnership with Amai Mnangagwa and Merck Foundation, Zimbabwean Obstetrician and Gynaecologist Dr Harrison Rambanepasi of United Bulawayo Hospitals is at IIRRH Hospital, Bangalore in India where he is currently undergoing the fertility training fellowship.

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