Q1 What is Semen?

A1 This is a grayish-white, viscous liquid that the male partner releases during intercourse or masturbation. This liquid, which usually becomes more watery (liquefaction) after a period of 30-45 mins, contains millions of cells known as spermatozoons (just like you have millions of fish in the sea) you have millions of spermatozoon in the semen.


Q2 What is Semen Analysis?

A2 This is the microscopic examination of the semen to reveal many characteristics of that particular semen sample.


Q3 What is Normal Semen?

A3 The World Health Organization has assisted in defining nearly universally acceptable normal semen parameters. A normal semen analysis therefore must have the following characteristics.

  • A volume of Semen of between 2-4ml
  • A sperm concentration greater than 20million per ml
  • Motility of sperm greater than 40% of total sperm present
  • Normal forms of sperm present greater than 30% of total.

In most cases of sperm sample that have produced babies, there is usually a high percentage of abnormal form 60%. This is acceptable in clinical practice.


Q4 What is Azospermia?

A4 This is a condition in which there are no sperm cells in the sperm produced (ejaculate)


Q5 What are the causes of male infertility?

A5 These can be grouped as follows

  • Infections in the testis or the tube that carry sperm from the testis to the outside resulting in inflammation, damage to the cells that produce sperm or obstruction to the passage or sperm tube.

A popular one is the infection called orchitis, which is caused by a virus called mumps virus. It is a common infection in childhood. Vaccinations are available for its prevention.

Other infections are caused by Gonorrhea, and Chlamydia.

“STAPHYLOCOCCUS AUREUS DOES NOT CAUSE MALE INFERTILITY”. These germs are usually contaminants of sperm specimen.

PLEASE STOP BELIEVING those ill-informed, untrained doctors who use this information to wipe up time, money and emotion from susceptible public.

  • Operation
  • Excessive smoking/drinking
  • Drugs especially those used in cancer treatment
  • Radiation and radiotherapy
  • Varicocoele: This is a condition in which the veins surrounding the test becomes unusually dilated. The resulting increase in temperature in the area decrease sperm production and function.
  • Sometimes, some people have antibody in their semen which can attach to sperm cells from fertilizing the egg.
  • Other causes are
    • Undescended testis: When the male testis has not descended into the scrotum at birth.
    • Some rare abnormally/deficiency in the hormones required in sperm (Hypogonadotrophic Hypogonadism)


Q6 What is Low Sperm Count?

A6 This simply means that the number of sperm in the ejaculate is less than 20million/ml as defined by the W.H.O. However; there are other reasons for abnormality in a sperm sample other than a low sperm count.


Q7 What is Watery Sperm?

A7 I decide to include this question in this publication in order to clarify what actually constitute a “watery sperm”.

Generally, term is used to describe a poor quality sperm sample principally on account of the sperm not being “thick” or viscous enough when observed.

It should be understood however, that most times, sperm is grayish-white and viscous when freshly passed but becomes liquefy within 30 to 45 minutes. Observing a sperm sample after this period of time may give an erroneous impression of the sperm sample being “watery”.


Q8 How does Low Sperm Count cause Infertility?

A8 Nature has always been kind to Human beings. An adequate number of normal, actively motile sperm ensures that more sperm can travel from the vagina through the cervix to the womb. From the womb, the active sperm cells then pass into the tubes to fertilize the egg.

However, it is to be noted that the vaginal environment, the cervix and its mucus, the cervical canal and the womb’s cavity all present varying degree of “hostility” or impediments to the sperms movement and survival. Only the fit would survive to reach the egg in the tube. Therefore, in case of low sperm count, only few or none of the sperm would reach the egg and no fertilization takes place.


Q9 Is it possible to boost Sperm Count?

A9 Essentially, the answer is no.
This is so in the context of using some medications to increase sperm production since such drugs do not make sperm cells.

However in cases where sperm count is low due to non-stimulation of the testis by the pituitary hormones, administration of such hormones .i.e. FSH would result in sperm production.


Q10 Does long period of Abstinence improve the quality of sperm?

A10 The answer is no. It doesn’t.
With longer than 4 days of abstinence, semen volume increases on production, but not necessarily its concentration. In fact, sperm count might actually reduce after longer than 4 days of abstinence. Certainly motility and progression might also decrease. We therefore strongly recommend about 2 to 4 days of abstinence prior to semen production for use in infertility laboratories.


Q11 Drug treatment and Male Infertility, what’s the relationship?

A11 More than 95% of men with low sperm count that present in my Infertility Clinic have used drugs to boost sperm production. The commonly used drug is PROVIRON.

Proviron is a testosterone compound. Usually such patients do not experience any improvement and indeed many experience worsening on their sperm count.
This is not surprising if one adequately understands the physiology and endocrinology of reproduction. The testis normally is endowed with the function of producing (a) sperm & (b) testosterone.

How would you then expect testosterone given from the outside (in form of Proviron) to adequately produce sperm? For God’s sake both sperm and testosterone are products of the testis. One of them cannot therefore produce the other. However testosterone can make the environment conducive and indeed naturally essential for sperm production but cannot make sperm on its own.

Rather than pump male patients up with testosterone compounds, such fake Doctors should refer such patients for assisted conception.


Q12 What are Varicocoele?

A12 There are numerous veins which surround the testis. Occasionally these veins become engorged i.e. (Varicocoele) and as a result the temperature of their surrounding (including the testis) is raised. This rise in temperature impairs sperm production and function.


Q13 Is infertility therefore linked to Varicocoele?

A13 There are numerous evidences both in research and in our Clinical practice that varicocoelectomy improves some semen parameters and pregnancy rate.
However, this is not to say there is strong evidence linking Varicocoele to infertility.


Q14 Is there anything the Clinic can do to improve the quality of produced sperm?

A14 Yes, there is. Routinely, in our assisted conception Clinic laboratory, we prepare sperm samples for use in in-vitro fertilization.

This is all in an effort to remove debris, reduce the number of dead sperms and generally improve the quality of the final preparation of sperm sample.


Q15 Why would a woman not ovulate?

A15 Common causes are;

  • Polycytic ovarian syndrome. This is a condition in which the woman’s ovaries have small peripherally placed “cyst”. The woman MAY be obese, a bit more hairy than expected for a woman. Her periods may be very irregular and ovulation therefore irregular. She may present to the Doctor because of inability to achieve pregnancy.
  • Excessive weight loss and thinness (Anorexia Nervosa)
  • Advanced maternal age
  • Menopause
  • Excessive prolactin secretion
  • Radiation

Rare causes include Turner’s syndrome – This is an in-born problem in which the ovaries are virtually non-existing and therefore cannot produce eggs.
DO NOT FORGET that there is no ovulation during PREGNANCY and the use of contraceptive pills.


Q16 How would I know if I have ovulation problems?

A16 Generally speaking, a woman who has a regular cycle should be ovulating regularly (except in few instances).

With anovulation, your periods are likely to be irregular, delayed or absent.
Also, you could be the type who normally experiences slight abdominal pain during ovulation associated with thin and drawy discharge. These signs may be absent during an anovular cycle


Q17 Is it possible to have periods without ovulating and vice-versa?

A17 Yes indeed.
Periods occur as a result of the effect of hormones (produced by the eggs during their maturation) on the womb lining.

Sometimes and rarely, the ovary would have produced a mature egg which failed to be released (a condition called unruptured follicle syndrome). Vice-versa, menstruation may occur without a preceding ovulation (anovular menstruation) as it occurs in some abnormality that relates to Polycystic ovaries mentioned above.

The important fact to note is that these causes are rare and in any case a visit to your gynaecologist would open the way for a correct diagnosis and management.


Q18 How is ovulation diagnosed?

A18 The right person to diagnose ovulation is your Doctor.

Apart from asking questions to know whether you notice any mid-cycle pain or change in your cervical mucus from white and thick to thin, transparent and drawy, he would also perform laboratory hormone test usually 7 days to your expected period of a regular cycle; for example on the 21st day of a 28-day cycle.
Also strip tests are now commercially available which can reasonably predict and confirm ovulation.

The use of temperature chart, monitored by the Doctor is age-long, cumbersome and the expected fall and subsequent rise in temperature can be easily interfered with.


Q19 My Doctor told me I have hormone imbalance, what does this mean?

A19 The phrase hormone imbalance is a colloquial language used by the public in describing abnormal hormone test result.

It is important to note that the abnormal hormone results are not the problems but are just a reflection of abnormalities that need correction.

Please see your gynaecologist for advice, reassurance and further management.


Q20 What is high Prolactin?

A20 This simply means that the level of this hormone in the blood is higher than the acceptable level.

In a woman who has regular cycle and periods therefore, a high prolactin level is not significant. Prolactin is a brain hormone which at a very high level can negatively influence the other brain hormones that promote your ovulation.

In those who have high prolactin, with irregular or no periods, a visit to your gynaecologist is advised.


Q21 What treatment are available for ovulation?

A21 Like in most cases in clinical medicine, the treatment of ovulation is of the cause. For example, cases of P.C.O causing infertility needs referral to a gynaecologist for ovulation induction treatment.

Similarly, weight related ovulatory disorder needs careful counseling, dietry advice and weight gain.


Q22 What is the treatment for high Prolactin level?

A22 High level of prolactin could be treated with drugs such as Bromocriptine (Bromegon or Parlode).

However, prior to such treatment, it is very important to exclude the presence of brain tumor as the cause of the high prolactin level. Failure to do this will lead to worsening of the tumor and its effect.


Q23 Are there stronger fertility drugs other than Clomid?

A23 Yes, there are.

However, their usage is accompanied by the production of many eggs and the consequent risk of multiple pregnancy and also over stimulation syndrome which also carry serious risk to health. These drugs which are usually injections should therefore be used only under a gynaecologist’s supervision and ultrasound scan guidance.


Q24 What are fallopian tubes?

A24 They are internal structures about 5.5cm long, attached to the top of the womb, one on each side. They are necessary for the transportation of eggs from the ovaries (at one end) to the womb (at the other end).


Q25 What diseases affect the tubes?

A25 These include;

  • Blockage of the hole in the tube usually due to pelvic infection secondary to sexually transmitted infection or tuberculosis
  • Formation of scar tissue around the tube, which may directly block the tube or cause displacement thus affecting egg transport through the tube.

Q26 How would I know if I have tubal disease?

A26 From the above, you would need to search your mind as to whether you have had pelvic surgery before i.e. as a result of ectopic pregnancy, ruptured appendix, abortion complicated by infections or past history of sexually transmitted diseases such as gonorrhea and Chlamydia.


Q27 How can tubal disease be diagnosed?

A27 Conventionally, this is done using an X-ray. The procedure is called Hysterosalpingopraphy (HSG).

Dye is injected into the womb and tubes while X-ray is taken of the region, leaving an impression on a plate and film.

Many patients express discomfort and pain during this procedure as a result of the dye used. THE GOOD NEWS IS there is now a new dye which does not cause such PAIN.


Q28 What is laparoscopy &dye test?

A28 This is an alternative method for assessing the patency of the tube.

The passage of a blue dye from the cervix while the gynaecologist is looking from above (via the umblicus) allows tubal patency to be documented. It also allows the gynaecologist to have a real view of all the pelvic organs.


Q29 Which is better HSG or Laparoscopy & Dye test?

A29 In practice, both procedures complement each other.

While HSG is cheaper and simpler, many patients complain of pain and discomfort during the procedure. Laparoscopy on the other hand although gives a real time view of the pelvic organs and evidence of patency of the tubes, it however requires anaesthesia.


Q30 Can scan diagnose tubal problems?

A30 Yes, scan can be used to diagnose swelling associated with the tubes – hydrosalpinx.

Ordinarily however, scan cannot generally detect fallopian tubes or its patency when not diseased but such tubes that are swollen are usually already blocked and the lining damaged.
N.B A new technique called hysterosonogroephy allows us to do a scan while injecting water or contrast into the womb and tubes in order to visualize these structures.


Q31 Can I have surgery to open my blocked tubes?

A31 Yes, you can. However, the type of surgery is determined by the site and extent of tubal damage. Before the advent of Assisted Conception techniques, tubal surgery was the only hope to attempt correcting tubal damage. It is very expensive and cumbersome as microscope is used in the operations. More importantly however, pregnancy rates were disappointingly low.


Q32 I have one blocked and one open tube, what are my chances of achieving conception?

A32 We used to say that one open tube is as good as two open tubes. This is based on the knowledge that eggs from the side of the blocked tube could migrate to the other side and enter the tube.

The reality however is that tubal disorders tend to be bilateral. Generally therefore, failure to achieve pregnancy after three (3) years of unprotected intercourse with one blocked tube is an indication for Assisted Conception treatment such as IVF.


Q33 What is hydrotubation?

A33 This is some traditional method of supposedly unblocking the tubes by injecting some mixture of liquid and antibiotics into the womb via the cervix.
The reality however is that tubal blockade is caused by scarring as a result of infection. Hence, no amount of hydrotubation will remove scarred tissue.


Q34 What is the current treatment of tubal disease?

A34 The modern treatment of tubal disease is In-vitro fertilization (IVF). Details of this is available on request.