Wednesday, 27th September 2023

How male chauvinism, Myth, ignorance, others fuel childlessness in marriages

By Eno-Abasi Sunday
17 September 2023   |   3:50 am
Computer experts Nnaemeka, and Chidinma were 44 and 34 respectively when they decided to move things several notches higher in their four-year-old friendship, by getting married, having dated for five years. 

Computer experts Nnaemeka, and Chidinma were 44 and 34 respectively when they decided to move things several notches higher in their four-year-old friendship, by getting married, having dated for five years. 

With a combined monthly income of well over N1 million, both parties had no qualms about tidying up formalities, observing the traditional marriage rites, and eventually staging a colourful wedding all within four months of planning. 
An extended honeymoon granted them by their respective employers, which saw them savour conjugal bliss to the best of their ability, added to the fun and romantic verve that surrounded the formalisation of their union. 
As health-conscious persons, the information technology experts had, ahead of the wedding, subjected themselves to medical tests. Chidinma specifically carried out comprehensive tests, including blood group/compatibility test, fertility test, genetic medical history, HIV/STDs, and blood group. Nnaemeka did only “the basic tests” before they got married.
After six months of unmitigated conjugal loyalty, Chidinma expressed concerns over her inability to get pregnant. The first time she brought her concerns before her husband, he laughed it off heartily, and jokingly asked for more sex sessions for “things to align.” 
Whatever that meant, Chidinma refused to despair but took things in her strides. In the ninth month, she again voiced her concerns, stressing that if she failed to take in by their first wedding anniversary, she would seek medical attention.

Exactly that she did, and in the process underwent a series of tests, during which she was given a clean bill of health. After the consultant who attended to her at the Lagos University Teaching Hospital (LUTH) certified her medically fit for childbearing, Chidinma was asked to get her husband to undergo a semen analysis test in a major medical laboratory located in the Oshodi part of Lagos.

The consultant was shocked to see Chidinma with the result of her husband’s semen analysis on her next clinic day. Surprised at the speed with which Nnaemeka complied, the consultant asked Chidinma to count herself lucky for having an understanding husband.

Upon the examination of the test result, the consultant noticed what looked like the source of Chidinma’s problem. Her husband was suffering from Oligospermia, which is the production of low or poor-quality sperm. With the problem detected, it took a few months for Chidinma to take in.

What Chidinma got on a platter of gold, another woman that is in similar shoes was not that lucky, and the issue became a full-blown controversy in another household.
Adesua and Omoregie were married for five years without children, and for the entire period, Omoregie bluntly refused to subjecting himself to any medical test to establish his fertility status. 
Because of the stigma attached to male infertility, Omoregie alleged that it was forbidden, and an insult for any doctor to suggest that he may be infertile hence the need for medical tests. Surprisingly, Omoregie’s sisters backed him and threw subtle shades at their sister-in-law accusing her of “aborting all her babies” before getting married to their brother.
Unable to stomach the hurt and emotional trauma, Adesua sought a divorce, remarried a year later, and had her first baby at 37, ten months after her new wedding.

Childlessness, loosely defined as the absence of children in a marriage can significantly affect the dynamics and overall happiness within a union. In addition to contributing to marital dissatisfaction, it also leads to unrealised parenthood expectations since many couples enter into marriage with the shared expectation of procreating, becoming parents, and building a family.

When these desires are thwarted or unfulfilled as a result of infertility, health constraints, or personal choice, it can ultimately breed feelings of disappointment, frustration, and unfulfilled dreams. 

In later life, exasperation arising from the absence of children could give room for feelings of loneliness, which could overflow during notable life events, or after retirement, where support typically provided by adult children comes in handy.

With the significant emotional gap and strain in the relationship that the absence of children is capable of creating, some marriages have no such capacity to weather the attendant outcomes, including, but not limited to absence of marital happiness, loss of affection, feeling of inadequacy, and overall loss of marital satisfaction. 

Male Infertility As Age-long Myth, Stigma
WITH the gamut of complexities that childlessness causes in marriages, it is, however, heartwarming to find out that the right medical attention sought at a good time can restore happiness in marriages, through the arrival of children. 

But there is a snag. Many men, for reasons best known to them, without medical examination always, strangely certify themselves medically fit to bear children. Oftentimes, they remonstrate that there is nothing wrong with them hence they are not liable for the union’s childlessness.

On the other hand, as ignorance persists, male chauvinism gains ascendency, and male infertility myth spreads wider, etc, society is increasingly seeing childlessness as a woman’s problem.

Experts maintain that male factor infertility is responsible for between 40 to 50 per cent of all infertility cases in Nigeria, but despite this high prevalence, not much attention is paid to the scourge. This explains why concerns are mounting that the cumulative impact of male factor infertility may likely soar if adequate measures are not taken.

Infertile men, they add, also have a higher risk of autoimmune disorders, including psoriasis, multiple sclerosis, rheumatoid arthritis, as well as, increased risk of prostate and testicular cancers.

According to the International Federation of Gynecology and Obstetrics (FIGO), there are 10 major reasons for male infertility, although they typically do not manifest visible symptoms. Often, male infertility is only identified after a couple’s persistent, unsuccessful attempts at conception.

The body also notes that couples and individuals who desire, but are unable to achieve a healthy pregnancy have needs that must be addressed – infertility and subfertility, which affects an estimated 48 million couples (about 15 per cent) of reproductive age worldwide.

FIGO enumerated the 10 major reasons for male infertility to include varicocoele, high testicular temperature, genital injuries, infections, supplements and steroids, radiation, nutrition, obesity, smoking/addictive substances, and age.
Across cultures, regions, and locations, the sensitive topic, which subjecting men to fertility tests is becoming well-documented. That is why a United States-based fertility specialist, and co-founder, of RISE Fertility, Dr. Sanaz Ghazal quoted in an article entitled, “The Importance of Fertility Testing For Men,” on a fertility website, said: “There is a big cultural and social pressure…Male fertility has been for the longest time considered a stigma and taboo subject. Toxic masculinity and classic gender expectations and prejudice have dictated the narrative around this topic. Sperm is half of the future baby, and its health is just as important as egg health.” Because of this stigma, there can be certain sensitivity around discussions of infertility in people assigned male at birth. 
She continued: “They can feel like it’s questioning their manhood or their masculinity. It’s important for men to understand the factors, as well as, their options and to realise that most of the time male infertility is not their fault. It’s nothing that they did wrong, or shouldn’t have done. It’s just their biology.” 
The Medical Director of Men’s Clinic, Ikeja, Lagos State, Dr, Rasheed Abassi, could not agree less with Ghazal. Not only did he stress that age affects fertility and pregnancy, he added that “the issue of male infertility and its intermixing with culture and tradition is a complex issue, yet delicate balance. Here are the facts: Infertility in general, and as a medical issue is an equal opportunity offender, meaning it affects both sexes equally. The notion that a man or any man is always fertile is not based on facts, and there is no basis in science. 
“What we know for a fact is that a man is a complex machine that is made to function and operate based on the quality and presence of two major hormones: testosterone and estrogen. Yes, men have and operate on estrogen as well. Physiologically, a man is supposed to have a higher level of testosterone and a much lesser level of estrogen. A man’s virility and fertility depends on the level of his testosterone. The higher the testosterone, the more likely he will be a fertile human. So, for any man to be sure of his fertility, he needs to take care of his testosterone production and maintenance.”
Abassi added: “Ironically, a man’s testosterone level is inversely related to his estrogen level. Research has shown that there are environmental and genetic factors that can and will influence a man’s testosterone level. Factors like diet and lifestyle, as well as, some form of medical issues: Type 2 diabetes and stress management. Having Men check their testosterone level is a great thing and medically recommended, if interested in becoming a parent. The idea that a man is always fertile is a myth and not based on scientific facts. Men have the factory to make semen.

However, the factory, and the testes, need all the appropriate raw materials which are healthy levels of testosterone, zinc, fructose, etc.  Shedding light on when men should initiate, or take steps to confirm their fertility level, especially those who did not get tested ahead of marriage, Abassi said: “Ideally, men should have their fertility level checked regularly and annually. Would-be fathers need to have their testosterone checked, just like it is very important to check their genotype before committing to any long-term relationship.”

Infertility A Couple’s Challenge, Not A Woman’s Problem
DESPITE the existence of a nexus between sexual health and the overall health of men, not many of them realise the importance of paying attention to their sexual health until things sometimes appear to go awry.
Conversely, in most developed countries and even in Nigeria, women are usually the first to consult their primary care provider (PCP) or gynecologist when they fail to get pregnant after robust, unprotected sexual engagements during their fertile periods. In other words, they are the first to seek medical attention whenever a union fails to produce children swiftly. Chidinma and Nnaeka’s case clearly illustrates this.
While professional help is important in seeking a solution to childlessness, it is also imperative to warn young people that the procreation window is limited hence the imperative of procreating early or freezing their eggs till they are ready to do so in the case of girls. 
A former president of the Royal College of Obstetricians and Gynaecologists, and a professor at Imperial College London, Prof. Dame Lesley Regan, while speaking at the annual conference of the fertility charity Progress Educational Trust (PET), last December reportedly said that we need to “do a lot more” to prepare teenagers for their fertility declining, including telling girls: “Your ovaries get worn out.”

“We need TikTok videos, don’t we, and all of those sorts of things: ‘Remember that your ovaries get worn out, or they get tired, or they get too old. We’ve got to impress on them the importance of all of those things, and of taking charge of their fertility, either to explore it or to curtail it.”
A major World Health Organisation (WHO) study revealed that 38 per cent of infertility cases were due to female causes, and 47 per cent were due to either male or combined male and female causes, while the remaining 15 per cent was categorised as “undetermined.”

Ignorance, Pride, Superstition As Enablers Of Childlessness
FOUNDER of Preggify, Dr. Ifunanya Lillian Igweze, is of the view that ignorance plays a major role in furthering childlessness in a union.According to a fertility expert: “Ignorance about the causes of infertility and the available treatment options can prevent couples from seeking medical help and delay the diagnosis of underlying medical conditions. This can lead to a prolonged period of childlessness and increase the emotional and psychological burden on the couple. 
“Pride can also prevent couples from seeking medical help, as they may be ashamed, or embarrassed to admit that they are experiencing difficulties with fertility. This can lead to a sense of isolation and prevent them from receiving the necessary support from family, friends, and healthcare providers. 
“Superstitions and cultural beliefs can also contribute to the problem of childlessness among married couples in Nigeria. Some couples may believe that infertility is caused by spiritual, or supernatural forces, and may seek traditional or faith-based remedies, instead of medical treatment. This can delay the diagnosis of underlying medical conditions and prevent couples from receiving appropriate treatment,” she stated. 
The online pregnancy care service provider stressed that it is important to educate couples about the causes of infertility and the available treatment options, as well as to challenge cultural beliefs and superstitions that may prevent them from seeking medical help. By doing so, we can reduce the rate of childlessness among married couples in Nigeria, and improve their overall health and wellbeing.
“It is important to point out that men’s declining fertility evaluation is a major barrier to proffering solutions to infertility. Not just in conception, but in medical conditions. When a resistance of such is raised, it becomes difficult and almost impossible to reach any solution and it is sad to see that a lot of men fall in this category. This is often because of the societal view of seeing them as less men.

“However, this attitude of some men who refuse to undergo medical tests after experiencing childlessness can perpetrate childlessness in marriages in several ways. Firstly, male infertility can be a significant factor in a couple’s inability to conceive, and without proper diagnosis and treatment, the couple may continue to struggle with infertility. By refusing to undergo medical tests, men may be hindering their chances of starting a family and putting unnecessary strain on their relationship. 
Secondly, the attitude of “not being the problem” can create a sense of blame and shame within the relationship, with each partner pointing fingers at the other. This can lead to feelings of resentment, frustration, and even divorce. 
“Lastly, the stigma surrounding infertility can prevent men from seeking medical help, as they may feel embarrassed, or emasculated by their inability to conceive. This can perpetuate a cycle of childlessness, as men who do not seek help cannot receive the necessary treatment to improve their fertility. 

Age As Factor In Infertility In Male, Female
FERTILITY experts agree that men can indeed impregnate a woman at any age, even though they are also quick to admit that the quality of sperm that the man produces to fertilise eggs is of great importance. But to what extent is age a factor in infertility in both males and females? Igweze responded: “The decline in fertility due to age is a significant factor for both males and females. This is the most common factor considered in social settings when women are considered for marriage. Biologically, females are born ready with the exact number of eggs to sustain them during their reproductive life. Females experience a decrease in the quantity and quality of eggs as they age, leading to a decline in fertility. Women over 35 years old have a higher risk of infertility, pregnancy loss, and fetal abnormalities. 
“On the other hand, males also experience a decline in fertility with age, as the quality and quantity of sperm decrease. Men over 40 years old may have difficulties in conceiving due to a decrease in sperm count and motility. Not just that, advanced paternal age has also been linked to an increased risk of genetic disorders and developmental disabilities in babies. Although age is not the only factor impacting fertility, it is an important consideration for couples trying to conceive,” she said.
The author and speaker added: “It is hereby crucial for individuals to be aware of the potential impact of age on fertility. It is also worthy of note that the management of infertility in couples with advanced age isn’t the same for younger couples. It is pertinent to seek medical advice if they are having difficulty conceiving.”
Given the challenges thrown up by age, how compelling is it for teenagers to be taught that they will not be fertile forever? Igweze said it is very important. 

“It is essential for teenagers to be taught about fertility and reproductive health, including the fact that fertility declines with age. This knowledge can help teenagers make informed decisions about their sexual health and future family planning options. Also, educating teenagers about fertility and ensuring that intending couples undergo appropriate medical tests can help promote reproductive health and reduce the rate of childlessness among married couples.
“As for intending couples, it is recommended that they undergo several medical tests before marriage to assess their fertility and overall health. These tests may include a physical examination, blood tests to check for sexually transmitted infections, genetic testing, and semen analysis for men. Women may also undergo a pelvic examination, ultrasound, and other tests to assess their reproductive health. 
“Running fertility evaluation tests are often disregarded by couples because they believe they are young and fit. This isn’t right. As I said earlier, age isn’t the only cause of infertility. Couples need to undergo these tests before marriage to identify any underlying medical conditions that could affect their fertility or overall health. Early diagnosis and treatment of these conditions can improve their chances of conceiving and reduce the risk of complications during pregnancy,” she said. 
“In addition to medical tests, couples should also consider discussing their family planning goals and values before marriage. This can help them to identify any potential areas of conflict and work together to develop a plan that meets their needs and desires. Pre-pregnancy care, also called pre-conception care is important for both genders. Older men (more than 40 years), need to consider fertility evaluation. Knowing if there are underlying conditions that may affect fertility in time can help proffer solutions to it and prevent more damage.
“It is important for men who are planning to start a family and have not yet done so to consider getting a pre-marriage fertility evaluation, especially if they are older than 40. Fertility evaluations can help determine if any underlying medical conditions may be affecting their ability to conceive. These evaluations typically involve a physical exam, semen analysis, and blood tests to assess hormone levels. 
Sharing his perspectives on how age affects fertility in both sexes, a public health physician and health promotion specialist, Dr. Obinna Ebirim concurred that “age affects both males and females in distinct ways that are associated with the changes that occur within the male and female reproductive systems over time.
“In a female, fertility is at its peak during her 20s and early 30s. This period is characterised by regular menstrual cycles and a healthy ovarian reserve, leading to increased chances of successful conception. However, beyond 30 years, fertility begins to wane, with a more rapid drop after about 35 years. A key causative factor is the diminishing ovarian reserve because the female ovaries contain a limited number of eggs, which decreases in quantity and quality as the female ages. This reduces the likelihood of pregnancy. Additionally, advanced maternal age is associated with a decline in the health of the uterus plays a key role in conception/pregnancy, and increased risk of pregnancy complications such as diabetes and hypertension in pregnancy, miscarriages, and a greater likelihood of chromosomal abnormalities in the developing fetus,” Ebirim said.

He added: “Younger males tend to have higher sperm counts and superior sperm quality, which are key factors that enhance fertility although this is not a general case. Even though male fertility remains relatively stable until later in life, there is evidence to suggest that sperm motility may decline in their 50s and beyond. This can affect the ability of sperm to fertilise an egg leading to pregnancy or infertility. As men age, the number of genetic mutations increases leading to increased likelihood of congenital malformations in their newborns. Another aspect is the increased likelihood of erectile dysfunction in older men, which might not have a great effect on fertility but can affect the reproductive journey of couples.
“In conclusion, both men and women can continue to conceive as they age, but changes occur with time these changes have implications on their fertility. While females experience a gradual, but significant decline in fertility, males face slight changes in sperm quality and a greater likelihood of genetic impact on their unborn offspring. The good news is that science and medicine have advanced and continue to advance, offering more options and hope for fertility irrespective of age. Understanding these age-related dynamics and conducting medical checks to identify any of these above-mentioned conditions in older males or females (if they exist since they don’t in everyone), is important, as individuals and couples plan to conceive or enter into relationships in which conception is at its core.”