The male infertility crisis. 'When I see children playing, my heart breaks into tiny pieces'

It's the expected fruit for every couple that walks down the aisle. A child is what is said to cement a relationship, and so couples are under a lot of pressure to show the fruits of their love, within the year after saying I do.

But what if this doesn't happen? And what if after a lot of heartache and medical tests, the man is found to be the one with the issue? 

Male infertility is an issue that is little discussed in public or the media, but which affects a growing percentage of men today. 

The result is depression, paranoia, frustration, envy, and anger for most men. Counseling psychologists argue while most women are concerned about their infertility and are interested in learning more, the social stigma attached to male infertility makes it hard for men to talk about it or seek support. It doesn't help that in African culture infertility is taken as a female problem, and never something that afflicts males. 

In one of the Kenya Fertility Support Groups on Facebook, one man said. "It was tough for me to acknowledge I was infertile, as I had always thought it's a female problem." 

Dr. Wachira Murage, consultant obstetrician gynaecologist and infertility specialist at Savanna Healthcare Service Upper Hill says that lack of male participation in the clinic often delays the treatment process and hence, advocates for the total involvement of the couple in cases of childlessness. 

"We are witnessing an increase in the number of men blaming their wives for lack of children while in reality, males contribute to 30 percent of childlessness, 30 percent is caused by women, 20 percent due to shared factors, and 20 percent due to unknown factors," he says.

An analytical study at the Kenyatta National Hospital in 2020, found that male infertility has increased due to a worrying phenomenon of drug abuse that affects the stimulation of testosterone. While women tend to visit specialists trained in female reproduction, most men shy off from the matter and others result in secrecy after being diagnosed. 

By nature, women are aware of their fertility, as their monthly cycle is a prime indicator. On the flip side, most men have no innate monitor for their sperm's motility and hence, don't contemplate male reproductive health. 

Here four men share their deep and painful experiences of being childless. 

'When I see children playing, my heart breaks into tiny pieces'

James K'omuono, 50, Businessman: 

"Infertility is not an easy subject because of the stigma linked to it. I have had instances where my family members have insulted me saying "wewe huna jamii utatuwacha bure kabisa" (you will have no future generations; you are useless). 

Anytime I look at children playing in the park, I question God and wonder 'Why can't I have my own child? I am aging.' At first, I didn't want to talk to anyone about the issue, but after I lost three marriages I had to confess about my struggle with infertility. 

I spent most of my 30s trying to have a child, and the failure to do so left me depressed. I was committed to all my three marriages but unfortunately, no one could stand my predicament. I avoided alcohol, stopped smoking, and followed the approved advice to maximise sperm production, all to no avail. I visited different hospitals and till today, no specific issue has been diagnosed yet all the women I dated never got pregnant but when they left me, got children. 

Of course, I often feel short of what is required of me as a man, and the failure to get children has made me frustrated, envious, angry, and paranoid. Despite my business doing well, I wonder why I have to invest so much yet there are no generations after me."

'The news that I couldn't have a family was devastating'

Daniel Ochola, 48, Digital Strategist. 

"By the age of 25, I was already married and after an unsuccessful period of us trying to have children, we decided to visit the hospital. I recall going to see the doctor for the results, hoping that it was my wife's fault. I was shocked to know I was the one with the issue. I remember vividly how the doctor looked at me in the eyes and told: 'I am sorry to inform you that, you've got azoospermia, and surgery is needed to unblock your tubes.' Azoospermia is the medical term used when there are no sperms in the ejaculate. It can be "obstructive," where there is a blockage preventing sperm from entering the ejaculate, or it can be "nonobstructive" when it is due to decreased sperm production by the testis.

The surgery news hit me like a thunderbolt and I was plagued by thoughts of what the future held. I wondered if there was any reason to be alive. It was heart-wrenching for my wife but I am glad she stood by me. The journey was tough and at times I felt torn, and some days I wanted to vanish from the world. In 2018, our prayers were answered and my wife finally conceived. This is a miracle and I will forever be grateful to God."

'My ego was affected and I felt less of a man' 

Felix Andrea, 40, Accountant. 

"At 30, I was diagnosed with oligospermia, a male fertility issue characterised by low sperm count. I have always desired to have children but my desires were not met when I married at 25. At first, I wondered why my wife was not conceiving despite marrying her with a child from a previous marriage. The journey of sterility was tough as we were ridiculed even by those close to us, but my wife who is my best friend has been my pillar of strength. Often, we wondered why God would allow us to go through this. My ego was affected and there are instances I felt less of a man especially when we visited our friends and saw them having a good time with their children. Often, I wondered, 'Will a time ever come where I will hold my baby?' 

Luckily, I was given hormonal treatment and medications. After waiting for three years, God answered our prayer and we finally sired twins on 27th December 2021."

'They say men don't cry but there are times my emotions go haywire'

Antony (not his real name) 35, Businessman

"My wife and I got married in 2013. Back then, we had a dream of having a big family and often joked about who wanted more children. (I remember I tapped out at five, and my wife six.) Childlessness has been an excruciating experience that we were not ready for. It's been nine years of an unproductiveness blur together like a bad montage. I recall how prior to visiting the doctor we did countless pregnancy tests and the results always tore our hearts into pieces. It was at this point, we decided to go to the hospital and I was told that I had hormonal imbalances. 

My ego was battered despite being given treatment. We are still waiting to have a child and the journey is not easy. I thank God for my wife whose love has been enduring. She always reminds me that 'you are important with or without children.' This keeps me going irrespective of the stigma I face from society, especially from those I shared with about my struggle. 

The challenge has made me love God more because He has also been my greatest source of encouragement. There are times I look at my wife and marvel at how beautiful our children would be. They say men don't cry but there are times my emotions go haywire especially when I see children playing in the neighbourhood and my fellow age mates celebrate their newborn arrivals. On a monthly basis, we identify a children's home to support and our service is a total surrender that God is still faithful and will give us a child one day."

A woman's story: 'I was blamed and ridiculed for not conceiving yet the problem was with my husband'

Mary Atieno, 50, Teacher 

"In 2005, a test was conducted to determine whether my fallopian tubes were blocked. When the results showed that my tubes looked fine, I was shocked because my husband continuously blamed me for not conceiving. As I limped down the hallway towards the exit, my husband at my side, I asked myself 'Why then can't I get pregnant if my fallopian tubes are okay? For nearly two years, I was trucking my ovulation on my smartphone and increased the frequency in which we got intimate. 

Life was tough and I recall being ridiculed by my in-laws who would tell me: 'Time is not on your side, you need to get children.' I was refrained from discussing family matters with them as they felt I was incompetent. The stigma I encountered led me into depression and I was put on antidepressants for anxiety. 

After sharing with my counsellor about my struggles, she advised that we visit a competent urologist. True to her words, the urologist examined both of us and the results showed that my husband's white blood cell count was high. The results made him confess that he had secretly been smoking, a habit that can adversely affect sperm production and development. I was furious about the painful experiences I had gone through. My husband was given a prescription and after one year of quitting smoking, I became pregnant in December 2010. This was a great relief for me. Till today, many people thought I was the one with the problem but I protected my husband's image even after discovering he was the one who had the issue."

What statistics say

4.2 million 

The number of Kenyans require medical assistance to conceive. 

14.12 percent

The number of infertile men visiting KNH's fertility clinic doubled between 2013 and 2018 from 7.6 percent to 14.12 per cent according to a Kemri research

1 in every 5 couples 

Suffer from infertility according to data from the Kenya Fertility Society 

Most common male fertility problems

Zero sperm count, low sperm count, and blocked tubes according to the World Health Organisation 

The causes and treatment according to a doctor

According to Dr. Wachira Murage, consultant obstetrician gynaecologist and infertility specialist at Savanna Healthcare Service Upper Hill, a growing number of men have poor sperm quality, which is either the main or contributing factor of couples struggling to conceive.

"Male infertility is a hidden issue and women have been divorced for childlessness even in cases where the male problem is the one with the issue.

Problems with male fertility can be caused by Varicocele, a swelling of the veins which drain the testicle and lead to reduced sperm quality and quantity. Infections such as inflammation of the epididymis or testicles or sexually transmitted infection including HIV or gonorrhea can interfere with sperm production, sperm health, or block the passage of sperm. 

Various health conditions such as spinal injuries, diabetes, and surgery of the bladder, urethra, or prostate can cause retrograde ejaculation. 

Cancers and nonmalignant tumors can also affect the male reproductive organs, hormone imbalances, defects of tubes, and undescended testicles. Certain medications such as chemotherapy, and some arthritis drugs can impair sperm production. 

Also, environmental causes such as chemicals, toxins, and heat reduce sperm function. Smoking, alcohol, miraa chewing can cause low sperm numbers. 

Diagnosis starts with getting a full history and physical exam, and blood and semen tests may be done. Treatment depends on what's causing sterility but majorly there is surgical or non-surgical therapy. We have seen success stories of people that conceived after the treatment," Dr. Wachira Murage. 

What to do

According to Dr. Susan Gitau, a counselling psychologist, lecturer at Africa Nazarene University, and founder of Susan Gitau Counselling Foundation, this subject is quite sensitive. Some situations of childlessness are corrected medically while others may not. That's why a couple should agree on what options to take if nothing works such as adoption. 

"In case you and your spouse have unsuccessfully tried getting a baby, go for a checkup. You shouldn't make assumptions or take medication without a prescription. It's important to embrace healthy lifestyle habits such as quitting smoking and excessive drinking, eating a healthy diet, exercising, and taking the treatment as prescribed by the doctor. Counselling is also key which helps in developing personal and interpersonal support in this moment of distress," Dr. Gitau says.

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