MEN: THE OTHER SIDE OF THE INFERTILITY COIN

In the African setting, the one responsibility bestowed upon women across the continent and that has gone unchallenged for generations is one of child-bearing. Along with the joys of motherhood, it has also brought pain and agony of untold proportions that is whispered about in hushed tones.

In Kenya, with the press highlighting the atrocities visited upon women who have not had babies and initiatives such as “Merck for Mothers”, the topic of female infertility is no longer as hushed. The availability of assisted reproductive technology is slowly spreading and discussions around the public health system requiring to address access to these services are beginning to take place.

The other side of the coin remains untouched though. What are we talking about? The male attitudes towards infertility remain a monolithic iceberg. A good proportion of men still have their heads deeply buried in the sand in the face of infertility. Statistics still remain the same; among couples with difficulties in conception, a third are as a result of the female partner issues, another third from male partner issues and the last third result from both partners having issues in tandem.

Nearly every doctor who handles couples with fertility issues have their own story to tell. Male partners dragging their spouses into the doctor’s office claiming that the partner is infertile and never acknowledging they could possibly be contributing to the current state of affairs. What is distressing is the arrogant tone that accompanies the said gentlemen.

I once saw a couple like this. The man adamantly claimed that his wife had failed in the only responsibility allocated to her, that of bearing him children. He was the family breadwinner ad believed he had provided her with everything, much to the envy of her peers. Yet she had not conceived in three years. When I enquired why he didn’t think he could possibly be contributing to their childless state, he proudly retorted that he had fathered two children in his previous relationships and hence had a proven track record of fertility.

His wife raised no resistance to the suggested investigative tests but I was able to get the man to consent to doing a semen analysis, should her tests raise no valid cause for their infertility. All the tests done gave her a clean bill of health and the gentleman had to oblige me and do the tests he had vehemently refused to. He was literally thunderstruck to find that his semen contained not a trace of sperm and he was virtually incapable of naturally impregnating his wife. He challenged the results and we were forced to repeat the test in two different labs for him to accept the situation.

They sought care abroad and through assisted reproductive technologies, the couple were able to conceive and give birth to a healthy set of twins. His ego was further crushed when he learnt that the babies he had proudly laid claim to previously did not belong to him despite years of diligent child support payments. He was a humbled man who was lucky to have such a forgiving wife.

In contrast was a couple I first met at the ante-natal clinic as a medical student. The patient was expecting a second baby and on this visit, the husband came along. Inadvertently, while addressing a different matter in relation to the pregnancy, it came to light that her previous baby could not possibly have been sired by the husband. While he went out to collect her laboratory results, she came clean and said that as far as she was concerned, she had done what was necessary to sustain her marriage.

Her husband had been married three times before and each time, the marriage dissolved under the pressure of inability to conceive. He laid the blame squarely on the women he had married and moved on to try again. After she met him and had not conceived after a year, the village gossip queens made the fate of her predecessors known to her. Instead of playing victim, she opted to take matters into her own hands and find home-grown solutions to the problem.

To make it happen, she fell back to the unspoken traditional practices, teamed up with her mother-in-law and in a few months, was well on the road to mother-hood, courtesy of her brother-in-law’s contribution. It had been a blissful four years in that marriage and she had no intention of allowing anyone to rock that boat. In her opinion, she had the moral sense to keep it within the family.

Of the routine tests required of a couple in investigating the cause of the infertility, men have it easy as they are required to provide a sample of their ejaculate for examination, a simple, non-invasive semen analysys test. On the other hand, women go through a slew of expensive and invasive tests that call for grit and patience. A hysterosalpingogram for instance, requires a radio-opaque dye to be introduced into the woman’s reproductive tract to ascertain the outline of the uterus and the patency of the fallopian tubes. It is invasive and quite uncomfortable for the woman but one that many at times, cannot be avoided.

It is high time our society opened up to acknowledging the contribution of male factor infertility so as to effectively engage in tackling the problem of involuntary childlessness. The most important take-home message to all men today would be: virility is not a measure of fertility. The capacity to have an active sexual engagement with outstanding libido does not in any way speak for the ability to contribute to successful conception of a baby.

Pulling out our heads from the sand is no mean feat. It requires a complete societal change in attitudes towards men and their fertility. We must desist from stigmatizing men who have fertility challenges, be more sympathetic and accepting so as to allow them to seek help instead of letting it out on their partners. Let us sustain positive conversations and demystify these challenges. The war on infertility cannot be won on the female front only!