1. Introduction

One of the main reasons for marriage is procreation¹. Infertility subject couples to great distress[2]. In Africa, women are often blamed while men assumed innocence. In some culture, it is an abomination to declare a man infertile. The blunt of infertility is often ignorantly borne by women[3].

The prevalence of infertility is high in sub-Saharan Africa, with a prevalence rate of 20-46% being quoted[2,4]. In Nigeria, various studies report incidence of 20-30 %[5]. In Western countries, 10-15% of couples experience infertility [2]. Male partners directly account for 25-30% of infertility and contribute to another 25 %[2, 6].

In majority of cases of male infertility, the causes of abnormal semen parameters are unknown[2]. However, some of the aetiologies are genital tract infections leading to obstructive azoospermia/oligospermia[6, 7] .Tuberculosis, gonococcal and Chlamydia infections are common in our environment[2, 7]. Bilateral viral orchitis especially after 12 years of age impair sperm parameters[2]. Congenitalabnormality (cryptochordism) and chromosomal disordersalso contribute to sperm abnormality[2].

The role of varicocoele is inconclusive. It occurs in 12% of normal men[2,8] .

However, studies showed that varicocoelectomyimproved sperm parameters[6,9] . Tobaccos, alcohol, cannabis, drugs and wearing of tight underwear are also implicated[2].

The task before an infertility clinic is to make diagnosis of the actual cause of infertility, and seminal fluid analysis (SFA) is very important in this regard[9].

Materials and Methods

This study was carried out at Mile Four hospital, Abakaliki. Mile Four hospital is a mission hospital dedicated to maternal and child health. It has a good microbiology laboratory dedicated to SFA. Couples are encouraged to visit the clinic together.

Couples managed for infertility over a-five year period (July 2005-July 2010) were reviewed. Seminal fluid data were reviewed paying attention to semen volume, concentration, motility, morphology and culture results.

Modified ‘masturbation’ was the main method of collecting semen in this hospital. Here the wife did the ‘masturbation’ in a dedicated room with dedicated bed and other facilities that made them relax.

Some men who lived very close to the hospital were allowed collect at home and brought to hospital within 15-20 minutes. In that case the laboratory scientists were ready for them to analyse the semen immediately within one hour of collection.

Masturbation is frowned at by many men for religious reasons. Withdrawal methods and the use of condoms were discouraged. Semen may be lost with withdrawal method or get contaminated with vaginal secretions. Condoms available in our environment are coated with spermicides. Non-medicated condoms (Milex limited) are not available in our environment.

Couples are educated on methods of collection and precautions that must be observed

Inclusion criteria: Men who accompanied their wives to the clinic and did the seminal fluid analysis (SFA).

Exclusion criteria: Men who refused to do the seminal fluid analysis.

W.H.O criteria for semen analysis are used in this hospital for SFA

W.H.O criteria for SFA:

• Volume 2ml or more

• PH 7.2-7.8

• Sperm conc. >20x10⁶ cell/ml

• Motility >50% forward movement

• Morphology >30% normal form

• WBC < 1x10⁶ cells/ml

Abnormal sperm parameters:

• Aspermia- no ejaculate

• Azoospermia-no sperm cell

• Oligospermia-<20x10⁶ sperm/ml

• Severe oligoserpia-<5x10⁶/ml

• Asthenozospermia-abnormal motility

• Teratozospermia-abnormal morphology

2. Results

Seven hundred and fifty five (755) male partners presented to the infertility clinic during the study period and had their seminal fluids analyzed.

Aspermia was recorded in 93(12.3%) of cases mostly in the age range 26-30 years (34%). Volumes of less than 2mls was found in 372(49.3%) of cases and greater than 2mls in 290(38.4%) of cases. OAT syndrome was commonest between the age range 41-45 years (46.7%). Abnormal sperm parameters affected all occupations and social class. Positive culture was obtained in 581(77%) and 174(23%) had negative cultures.

Testicular sonogram using a 7.5MHZ probe showed that 10% of participants had varicocoele.

Table 1. Socio-demographic characterstics of participants Age(yrs) NO % 21-25 34 4.5 26-30 165 21.9 31-35 135 17.9 36-40 139 18.4 41-45 223 29.5 46-50 43 5.7 51-55 16 2.1 Total 755 100 Occupation NO % Farming 263 34.8 Artisan 114 15.1 Business 101 13.4 Driver 98 13.0 Civil servants 56 7.4 Politician 49 6.5 Bankers 35 4.6 Teachers 31 4.1 Lecturers 8 1.1 Total 755 100

Table 2. Pattern of SFA SFA NO % OAT Syndrome 165 21.9 Normospermia 123 16.3 Oligospermia 119 15.3 Asthenteratozospermia 105 13.9 Aspermia 93 12.3 Teratozospermia 41 5.4 Oligo-asthenozospermia 32 4.2 Asthenozospermia 30 4.0 Oligo-teratozospermia 27 3.6 Azoospermia 20 2.6 Total 755 100

Table 3. Age and SFA

Table 4. Occupation and SFA

Table 5. Organisms implicated Organisms NO % Staph aureus 325 56 Kleb species 79 13.6 Strep species 66 11.4 Other coliforms 77 13.2 Multiple species 174 23 Candida species 34 5.8 Total 581 100

3. Discussion

The high number of men 755(97.3%) who presented to the clinic in company of their wives and did seminal fluid analysis as against the 21(2.7%) that refused or failed to do the SFA was in contrast with report from other centers which tend to state that African men do not like to do SFA[7, 9] The result can be attributed to good counseling from the gynaecologists and encouragement from fellow men attending the infertility clinic.

Moreso, there is increasing awareness that infertility is a problem of the couple and not of a woman only.

The high incidence of aspermia may be attributed to obstruction of the genital tract from high infection rate observed in this study. Genital tract infection is high in our environment and is a common cause of infertility[6, 7]

56.2% had low semen volume and compares with report from other workers[7, 8]

Low semen volume impairs sperm biochemicalinteractions and vehicular movement of spermatozoa[11]. 16.3% had normospermia by W.H.O standard[12]

This is lower than the result from Maiduguri (54%)[11]. the lower result may be influenced by sample size. Laboratory influence may also contribute.

21.9% had abnormality in the three sperm parameters: concentration, motility and morphology. The threeparameters are good predictors of fertility potential of given semen [11]. OAT syndrome has poor prognosis with conventional therapy requiring assisted reproductive technology (ART) which is not readily available in our environment and the few available ones are not within the reach of many infertile couples.

The prevalence of oligospermia and azoospermia is 15.3% and 2.6% respectively in this study. This is lower than results from other studies[7, 11,13, 16]. Sample size and laboratory influence may be responsible for this disparity. Also, our stringent measures and close supervision of both semen collection and laboratory techniques may also be responsible for the disparity. Some people have proposed 10x10⁶ sperms/ml as the lower limit instead of 20x10⁶/ml[14]

The contribution of varicocoele to this is inconclusive. In our tropical environment with its attendant heat,varicocoelectomy has been found to improve sperm parameters[7, 10].

There was lower prevalence of abnormal sperm motility in this study (44%) as opposed to 60% and 54% reported by other workers[9, 16]. The laboratory scientists in Mile Four were carefully trained and are dedicated to doing the SFA. At Mile Four hospital we insist that all semen must be analysed within an hour of collection. Exposure to latex, heat, spermicides and delay in analysing semen may lead to spurious results[8].

Seventy-seven percent (77%) had positive culture. Staphyloccocus aureus accounted for greatest proportion. This compares with other studies[6,7,8,11].

The high infection rate may reflect penile contamination. It may also reflect true infection which accounts for the high abnormal sperm parameters in this study[17].

4. Conclusions

There is high male infertility rate in our environment. There is the need to evaluate male partner in any infertility case[18]. Government, Non-Governmental Organizations (NGO), and donor agencies should assist in theestablishment of ART facilities in this part of the world.