When a couple can’t conceive in Nigeria, eyes usually turn to the wife. But men are involved in close to half of cases, and many never get tested. Here’s what male infertility is, how it’s diagnosed, and why the silence costs couples time.
Male infertility is common: a male factor is involved in close to half of couples who struggle to conceive. Causes include past infections, varicocele, hormone problems and lifestyle, and some are treatable. A simple semen test is the first step, ideally with both partners checked together.
It isn’t always the woman
In WHO’s large multi-country study, a male factor was involved in about 45% of infertile couples: on its own in roughly one in five, and alongside a female factor in about a quarter more. Nigerian clinic studies have found male involvement in roughly a third to nearly two-thirds of couples.
Yet women are often blamed regardless of the facts, and many men never get tested. At one clinic in Sagamu, a third of male partners refused a semen test. At another, in Birnin Kudu, only one in five came for one.
Why men stay silent
In much of Africa, having children is tied up with being seen as a man. Studies in South Africa, Ghana and The Gambia describe men with infertility facing teasing, stigma and a loss of standing. In an Ibadan survey, 44% of men agreed that witchcraft could cause infertility.
Men also tend to keep it to themselves, leaning on their partner and rarely on friends or support groups. In a Nigerian study, men accompanying their wives to a fertility clinic had about twice the rate of anxiety and depression symptoms as other men.
Common causes
- Past infections, including sexually transmitted infections that weren’t treated properly. Nigerian studies point to these as a leading preventable cause.
- Varicocele: swollen veins in the scrotum.
- Blockages in the tubes that carry sperm.
- Hormone problems.
- Ejaculation problems.
- Medicines and drugs, including anabolic steroids, testosterone, cannabis and some prescription medicines.
- Lifestyle: smoking, heavy drinking, obesity and heat around the testes are linked with poorer semen quality.
Often no single cause is found. Male infertility can also be an early sign of other health problems, which is another good reason to get checked.
The semen test
A semen analysis checks the number, movement and shape of sperm. You give a sample, usually by masturbation after two to seven days without ejaculating. If that isn’t acceptable to you, ask the lab about special collection condoms.
- One abnormal result isn’t a diagnosis. Guidelines advise repeating it after about three months.
- Test both partners at the same time. A woman’s age is the biggest factor in a couple’s chances, so testing one partner after the other wastes precious time.
What can be treated
- Some causes can be fixed or treated: a specific hormone problem, some blockages, infections that are found, and varicoceles in selected men.
- Other problems can be worked around with assisted reproduction, such as IVF with sperm injected directly into the egg. Our guide to the emotional side of IVF in Nigeria covers that path.
- Don’t take testosterone to boost fertility. It lowers sperm production. In a 2017 survey of doctors in Lagos, most wrongly believed it raises sperm count, so if it’s suggested for fertility, ask a specialist.
- Change what you can: stop smoking, keep drinking modest, work towards a healthy weight, and avoid anabolic steroids.
About “sperm boosters”
A NAFDAC number on a herbal product means it passed basic safety checks, not that it works: labels must say the claims haven’t been evaluated by NAFDAC. Large trials of fertility supplements found they didn’t raise birth rates. NAFDAC has also warned about “male enhancement” products containing hidden prescription drugs. Spend the money on proper tests instead.
Talking about it
The silence is often heavier than the diagnosis. Go to appointments together, tell one person you trust, and remember that a diagnosis is a medical fact, not a verdict on your manhood. Therapy can help with shame, low mood and strain in the relationship.
Suggested read: Situationships: Why They Hurt and How to Decide
You can find a therapist for couples and relationships, by video, voice or chat. Read more about infertility and mental health in Nigeria, men’s mental health and erectile difficulty.
Frequently asked questions
Is infertility usually the woman’s fault?
No. A male factor is involved in close to half of couples who can’t conceive. Infertility isn’t anyone’s fault, and both partners should be tested.
What causes male infertility?
Common causes include past infections, varicocele, blockages, hormone and ejaculation problems, some medicines and drugs, and lifestyle factors such as smoking and heavy drinking. Often no single cause is found.
How do I know if I’m infertile as a man?
A semen analysis is the first test. One abnormal result isn’t a diagnosis; it’s usually repeated after about three months, alongside tests for your partner.
Can male infertility be treated?
Often. Some causes can be treated directly, and others can be worked around with assisted reproduction. A specialist can explain your options.
Do sperm booster supplements work?
Large trials found no increase in birth rates, and a NAFDAC listing doesn’t prove a product works. Some “enhancement” products have contained hidden drugs.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
