Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 839

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Advertise Contacts Login 
     

  Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 56  |  Issue : 4  |  Page : 283-286  

Poor semen parameters among infertile couples presenting at a gynaecological clinic of Federal Medical Centre Birnin Kudu North-west Nigeria


1 Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria
2 Department of Medical Microbiology, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria

Date of Web Publication17-Nov-2015

Correspondence Address:
Emmanuel Ajuluchukwu Ugwa
Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin Kudu, Jigawa State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0300-1652.169746

Rights and Permissions
   Abstract 

Background: Male partners contribute significantly to infertile couple problem. The present study was undertaken to review the seminal fluid analysis (SFA) of couples presenting with inability to conceive at the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State using World Health Organization 2010 criteria, identify the correlation between poor semen quality and age and to identify culture and sensitivity patterns of isolates. Materials and Methods: This was a retrospective study. The sample size was 63 Ethical clearance was obtained. Patients' case records and laboratory registers were retrieved. The volume, viscosity, pH, sperm count, motility, and the morphology of the seminal fluid were determined. Semen m/c/s was done. Data were analyzed by using SPSS version 16 (SPSS Inc., Chicago, Il, USA). Descriptive statistics was used. Association between age and semen parameters were determined using Pearson's coefficient of correlations and Chi-square test and P < 0.05 was considered statistically significant. Main outcome measures: The proportion of infertile male with abnormal semen parameters. Results: Of the 308 couple presenting for infertility evaluation, only 63 male partners presented for SFA. This is 20.5% of the couples. After analysis, 52.38% were normospermic while 26.98% and 20.64% were azoospermic and oligospermic, respectively. Asthenospermia was the commonest motility/morphology abnormality occurring in 60.3%. The mean volume, sperm count, motility, morphology, and pH were 2.8 ± 1.8, 40.1 ± 52.3, 28.2 ± 27.7, 46.1 ± 35.6, and 8.3 ± 0.67, respectively. The volume, motility, morphology, and pH showed weak correlations with age. Conclusion: Male partners are significant contributors to the infertile couple problems in this study; therefore awareness is needed in order to engage more males in evaluation and treatment of infertility.

Keywords: Infertile couples, North-West Nigeria, rural setting, seminal fluid, tertiary hospital


How to cite this article:
Ugwa EA, Ashimi A, Abubakar M, Obadire S. Poor semen parameters among infertile couples presenting at a gynaecological clinic of Federal Medical Centre Birnin Kudu North-west Nigeria. Niger Med J 2015;56:283-6

How to cite this URL:
Ugwa EA, Ashimi A, Abubakar M, Obadire S. Poor semen parameters among infertile couples presenting at a gynaecological clinic of Federal Medical Centre Birnin Kudu North-west Nigeria. Niger Med J [serial online] 2015 [cited 2022 Jan 23];56:283-6. Available from: https://www.nigeriamedj.com/text.asp?2015/56/4/283/169746


   Introduction Top


Infertility is a common problem in Nigeria. Because of the much premium placed on children in traditional African setting and experiences of involuntary childlessness may cause marital disharmony. [1],[2] Some male partners often believe that they cannot be responsible for infertility, especially when there is no dysfunction of sexual functions such as erectile disorder. [3] Studies done in Nigeria have shown that poor semen quality is responsible for 20-40% of the infertile couple problem. [4],[5],[6] There have been reports that 30% of the cases of infertility are associated with male causative factors while 20% are associated with combined male and female factors. [7]

Seminal fluid analysis (SFA) was thought to be of no value in the past but is now accepted that every male infertility workup should start with the basics, namely, a thorough history, physical examination, and semen analyses. [7],[8],[9]

In order to establish evidence-based reference values for semen analysis, the World Health Organization (W.H.O) 2010 manual describes the values obtained in eight countries from 1953 men who became fathers with a time to pregnancy of <12 months. [7] Semen characteristics include volume, pH, sperm concentration, motility, morphology, and vitality. Azoospermia refers to the absence of spermatozoa in the semen ejaculate while, in oligozoospermia, the count is <15 million/ml. [7] Other lowest limits of normal are volume of 1.5 ml (hypospermia if <1.5mL), progressive motility of 32% (asthenozoospermia if <32%) and normal forms 4% (teratozoospermia if <4%). [7]

Sexually transmitted infections (STI's) such as Neisseria gonorrhoea and those transmitted through the urinary tract such as Staphylococcus aureus are known to affect the testicle. [10] These may lead to suboptimal sperm quality. Researchers have shown that early diagnosis and treatment are necessary to mitigate these problems which are associated with male infertility. [11],[12],[13]

Previous studies used an older version of W.H.O criteria for semen profile. [14],[15] The W.H.O 2010 manual has updated previous recommendations and provides new evidence-based findings and improved explanations of important concepts. The present study was undertaken to analyze seminal fluid parameters of couples presenting with inability to conceive at the gynecology clinic of Federal Medical Centre (FMC), Birnin Kudu, Jigawa State using W.H.O 2010 criteria, and to identify culture and sensitivity patterns of isolates. This will help recommendation regarding mass education and intervention to reduce male factor infertility.


   Materials and methods Top


This was a retrospective study of seminal fluid analyses of male partners of infertile couples presenting at the gynecological clinic of FMC Birnin Kudu, Jigawa State, Nigeria from September 01, 2013 to September 30, 2014. Ethical clearance was obtained from Health Research Ethics Committee of FMC, Birnin Kudu. The FMC is one of the Tertiary Health Facilities in Jigawa State. It was established for the provision of service, teaching and research to cater for the needs of the local and wider community. Patients from other hospitals and clinics are referred here. Birnin Kudu is a rural setting made predominantly of Hausa Muslims.

Patients' case records and laboratory registers were retrieved. A total of 308 cases of infertile couples were seen during this period. Only 63 of the male partners presented their semen for analysis. The samples were collected from patients who had 3 days of abstinence from sexual intercourse, using masturbation method. After collecting in a clean container, samples were transferred to the laboratory: Semen samples were examined within 1 h of collection. The volume of the seminal fluid was measured by decanting the whole sample aseptically into a graduated centrifuge tube, and the level was recorded in ml ±0.1. The pH was determined by spreading a drop of the sample evenly onto the pH paper. After 30 s, the color of the impregnated zone was compared with the calibrated strip. The viscosity of the sample was determined with the aid of Pasteur pipette. A drop of semen was allowed to fall back to the sample, and the length of the thread was observed. The counting chamber was used for the count. One-twenty dilution of semen prepared with formol saline as diluents. Total motility of the samples was determined by applying a drop of the sample onto a slide, covered with a cover slip. The sample was then viewed under the microscope using ×40 objective lens. The microscopy was done systemically, and accordingly motility of each Spermatozoon encountered was graded rapid progressive motility, nonprogressive motility and immotile. The number of spermatozoa in each category was counted with the aid of a laboratory counter. Usually, four to six fields were viewed to classify 100 successive spermatozoa. All motile spermatozoa with the ones that had their heads moving were recorded. Sperm morphology and vitality were determined by using pap and eosin-nigrosin staining technique.

Culture of seminal fluid samples was done in an aseptic condition, within 1 h of the collection; the seminal fluid was cultured using blood agar, chocolate agar, and MacConkey Agar at 37°C for 24 h. The cultures were examined for growth and antibiotics susceptibility testing were done accordingly. [16],[17] Data were analyzed by using SPSS statistical software (SPSS Incorporated, Chicago, Il, USA). Descriptive statistics such as frequency, percentage, and central tendencies such as mean and standard deviation were computed for data presentation. The association between age and semen parameters was determined using Pearson's coefficient of correlations and Chi-square test and P < 0.05 was considered statistically significant.


   Results Top


Of the 308 couples presenting for infertility evaluation, only 63 male partners presented for SFA giving a proportion of 20.5%. As shown in [Table 1], the mean age of the male partners was 34.1 ± 5.8 and most of the males were 25-30-year-old and followed by those who were 36-40-year-old. [Table 2] shows that 52.38% were normospermic, while 26.98% and 20.64% were azoospermic and oligospermic, respectively. As shown in [Table 3], asthenospermia was the commonest motility/morphology abnormality occurring in 60.3% of cases and other forms such as oligoasthenoteratozoosprmia and oligoasthenozoospermia were also quite common each occurring in 33.3% of cases. In [Table 4], it is shown that the mean volume, sperm count, motility, morphology, and pH were 2.8 ± 1.8, 40.1 ± 52.3, 28.2 ± 27.7, 46.1 ± 35.6, and 8.3 ± 0.67, respectively. The proportion of males with hypospermia was 17.6%. The volume, motility, morphology and pH showed weak correlations with age. There was isolation of bacteria predominantly Kleibsiella species (66.6%) and Pseudomonas aeruginosa (33.3%) in 13.6% of cases and these were very sensitive to amoxicillin, ampicillin, streptomycin, gentamycin, ciprofloxacine and levofloxacine.
Table 1: Age distribution

Click here to view
Table 2: Distribution of sperm count

Click here to view
Table 3: Distribution of motility and morphology abnormalities

Click here to view
Table 4: Semen profile and age-related correlation

Click here to view



   Discussion Top


Studies done in Nigeria have shown that poor semen quality is responsible for 20-40% of the infertile couple problem. [4],[5],[6] The present study has shown that only 20.5% of male partners of infertile couples presented for SFA. This proportion was low when compared with an earlier study where about 67.5% presented for SFA, that is, 56 out of 83 (18). Some male partners often believe that they cannot be responsible for infertility, especially when there is no dysfunction of sexual functions such as erectile disorders. [3] Moreover, in a polygamous setting as seen in the environment where the current study was carried out, couples are reluctant at presenting for SFA when the husband already has fathered children from other wives.

The mean age of the male partners was 34.1 ± 5.8 and most of the males were 25-30-year-old and followed by those who were 36-40-year-old. This is similar to previous studies, although the proportion in this age group was higher. [18] Some workers in Sudan similarly reported a mean age of 38.2. [19] Genitourinary tract infections, including STI's could occur in this group and some studies have associated the presence of bacteria in semen as a cause of poor semen parameters. [10],[20],[21]

In this study, 52.38% of male partners were normospermic while 26.98% and 20.64% were azoospermic and oligospermic respectively. An earlier study in Kano Metropolis by Agu et al. [22] reported azoospermia (14.2%) and oligospermia (39.4%), values which were lower and higher than the present study, respectively. Another study reported twice oligospermic men as those of this study. [10]

In this present study, asthenospermia was the commonest motility/morphology abnormality occurring in 60.3% of cases and other forms such as oligoasthenoteratozoospermia and oligoasthenozoospermia were also quite common each occurring in 33.3% of cases. These were higher than those from a recent study in the south-west which reported that the patterns of semen parameters noted in infertile males were oligozoospermia, teratozoospermia, asthenozoospermia, azoospermia, oligoteratozoospermia, oligoasthenozoospermia, and oligoasthenoteratozoospermia, asthenoteratozoospermia found in 25.6%, 18.5%, 11.5%, 6.2%, 3.2%, 2.3%, 2.1%, and 0.9%, respectively. [23] Agu et al. also reported morphology and motility abnormalities which were far lower than those of the present study.

This study has shown that the mean volume, sperm count, motility, morphology, and pH were 2.8 ± 1.8, 40.1 ± 52.3, 28.2 ± 27.7, 46.1 ± 35.6, and 8.3 ± 0.67, respectively. Because of the high proportion of males with normal seminal fluid volume in this study, it seems that fertility is affected little by seminal fluid volume. This has been similarly reported in a study carried out in Sudan. [19] The volume, motility, morphology, and pH showed weak correlations with age. The weight of evidence primarily from clinical studies suggests that age is associated with diminished semen volume, sperm motility and/or sperm morphology, [24] but that sperm concentration is affected little by age. [25],[26],[27]

The proportion of culture-positive semen reported in this study was 13.6%. This was lower than 30% [10] reported elsewhere. The lower culture rate may be due to abuse of antibiotics among our patients. Interestingly, Kleibsiella species was isolated in 66.6% and P. aeruginosa in 33.3% of culture positive semen which were largely sensitive to penicillins, aminoglycosides, and quinolones. These are among the very affordable antibiotics. Some authors have reported dominance of Escherichia coli, Enteroccocus faecalis and Micrococcus, [20] Neisseria gonorrhoea and S. aureus.[10] Although, the cause-effect relationship between bacterial infections and semen contamination and male infertility is still unclear [28] some researchers described, in an in vitro study, a negative influence on membrane integrity of human sperm head, neck, and midpiece. [29]

Male partners are significant contributors to the infertile couple problems in Birnin Kudu, Jigawa State, Nigeria as the prevalence of poor semen parameters was higher than those of other studies; therefore, awareness is needed in order to engage more males in evaluation and treatment of infertility. The limitation of this study is that it did not investigate etiological factors of poor semen parameters or cause-effect relationship. Therefore, future research is anticipated to fully understand the etiology of poor semen parameters among infertile couples in Birnin Kudu, Jigawa State. The clinical significance of bacteria in semen is still unclear and requires further studies.


   Acknowledgments Top


The authors acknowledge the support of records and laboratory science department in data collection stage of this research.



 
   References Top

1.
Abari CA, Audu DT. A study of street children in Kaduna metropolis, Nigeria. IOSR J Hum Soc Sci 2013;15:44-9.  Back to cited text no. 1
    
2.
Guz H, Ozkan A, Sarisoy G, Yanik F, Yanik A. Psychiatric symptoms in Turkish infertile women. J Psychosom Obstet Gynaecol 2003;24:267-71.  Back to cited text no. 2
    
3.
Chukwudebelu WO. The Role of Nigerian Males in Infertility and Subfertility in Africa. Adedovoh BK, editor. Ibadan: Caxton Press; 1974. p. 85-7.  Back to cited text no. 3
    
4.
Ajabor LN, Ezimokhai M, Kadiri A. Male contribution to subfertility in Benin city. Trop J Obstet Gynaecol 1981;1:53  Back to cited text no. 4
    
5.
Anate M. The infertile couple problem; Role of family planning clinics. Niger Med Pract 1991;3:26-32.  Back to cited text no. 5
    
6.
Ladipo OA. Seminal analysis in fertile and infertile Nigerian men. J Natl Med Assoc 1980;72:785-9.  Back to cited text no. 6
    
7.
Cooper TG, Aitken J, Auger J, Noonan G, Backer J. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5 th ed. Switzerland: WHO Press; 2010. p. 1-114.  Back to cited text no. 7
    
8.
Chong AP, Walters CA, Weinrieb SA. The neglected laboratory test. The semen analysis. J Androl 1983;4:280-2.  Back to cited text no. 8
    
9.
Agarwal A. What is the future of the sperm analysis. J Clin Embryol 2009;12:3-4.  Back to cited text no. 9
    
10.
Ramesh ST, Girish Babu RJ, Srikrishna R, Vinay Kumar K. Semen analysis and culture in men undergoing fertility evaluation. J Pharm Biomed Sci 2013;34:1699-703.  Back to cited text no. 10
    
11.
Jimoh AA, Olawuy TS, Omotoso GO, Oyewopo AO, Dare JK. Semen parameters and hormone profile of men investigated for infertility at midland fertility centre, Ilorin, Nigeria. J Basic Appl Sci 2012;8:110-3.  Back to cited text no. 11
    
12.
Emeakaroha MC, Obi RK, Nwanebu FC, Ogbulie JN, Uwaezuoke JC,Ohalete CN. Antibiotic sensitivity pattern of bacterial isolates from semen of men with infertility problem. World J Pharm Pharm Sci 2012;1:1198-20.  Back to cited text no. 12
    
13.
Momoh AR, Idonije BO, Nwoke EO, Osifo UC, Okhai O, Omoroguiwa A, et al. Pathogenic bacteria-a probable cause of primary infertility among couples in Ekpoma. J Microbiol Biotech Res 2011;1:66-71.  Back to cited text no. 13
    
14.
Adeniji RA, Olayemi O, Okunlola MA, Aimakhu CO. Pattern of semen analysis of male partners of infertile couples at the University College Hospital, Ibadan. West Afr J Med 2003;22:243-5.  Back to cited text no. 14
    
15.
Aneela Habib Shaikh, KhalidaKhalique, Gulfishan Tariq, Nargis Soomro. Pattern of semen abnormalities in couples with male factor infertility. Pak J Surg 2011;27:204-8.  Back to cited text no. 15
    
16.
Collee JG, Duguid JP, Fraser AG. Laboratory strategy in the diagnosis of infective syndromes. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney, Practical Medical Microbiology. 14 th ed. Edinburgh: Churchill Livingstone; 1996. p. 84-90.  Back to cited text no. 16
    
17.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; 17 th Informational Supplement. CLSI/NCCLS Document M100-S17. Vol. 27. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute; 2007. p. 1-177.  Back to cited text no. 17
    
18.
Olatunji AO, Sule-Odu AO. The pattern of infertility cases at a university hospital. West Afr J Med 2003;22:205-7.  Back to cited text no. 18
    
19.
Mohammed E, SIUF, Mustafa M, Khalid E, Nasrden Y, Mohamed EE, et al. Semen analysis of infertile sudanese males in Gezira State central Sudan. Sudanesse J Public Health 2009;4:404-44.  Back to cited text no. 19
    
20.
Moretti E, Capitani S, Figura N, Pammolli A, Federico MG, Giannerini V, et al. The presence of Bacteria species in semen and sperm quality. J Assist Reprod Genet 2009;26:47-56.  Back to cited text no. 20
    
21.
Fraczek M, Szumala-Kakol A, Jedrzejczak P, Kamieniczna M, Kurpisz M. Bacteria trigger oxygen radical release and sperm lipid peroxidation in in vitro model of semen inflammation. Fertil Steril 2007;88 (4 Suppl):1076-85.  Back to cited text no. 21
    
22.
Agu O, Ibrahim SA, Muhammad Z. Determination of the semen quality in male partners of infertile couples in Aminu Kano Teaching Hospital, Kano: A three year review. Ibom Med J 2011;1:17-22.  Back to cited text no. 22
    
23.
Owolabi AT, Fasubaa OB, Ogunniyi SO. Semen quality of male partners of infertile couples in Ile-Ife, Nigeria. Niger J Clin Pract 2013;16:37-40.  Back to cited text no. 23
[PUBMED]  Medknow Journal  
24.
Kidd SA, Eskenazi B, Wyrobek AJ. Effects of male age on semen quality and fertility: A review of the literature. Fertil Steril 2001;75:237-48.  Back to cited text no. 24
    
25.
Berling S, Wölner-Hanssen P. No evidence of deteriorating semen quality among men in infertile relationships during the last decade: A study of males from Southern Sweden. Hum Reprod 1997;12:1002-5.  Back to cited text no. 25
    
26.
Lemcke B, Behre HM, Nieschlag E. Frequently subnormal semen profiles of normal volunteers recruited over 17 years. Int J Androl 1997;20:144-52.  Back to cited text no. 26
    
27.
Spandorfer SD, Avrech OM, Colombero LT, Palermo GD, Rosenwaks Z. Effect of parental age on fertilization and pregnancy characteristics in couples treated by intracytoplasmic sperm injection. Hum Reprod 1998;13:334-8.  Back to cited text no. 27
    
28.
Ombelet W, Bosmans E, Janssen M, Cox A, Vlasselaer J, Gyselaers W, et al. Semen parameters in a fertile versus subfertile population: A need for change in the interpretation of semen testing. Hum Reprod 1997;12:987-93.  Back to cited text no. 28
    
29.
Qiang H, Jiang MS, Lin JY, He WM. Influence of enterococci on huma. Asian J Androl 2007;9:77-81.  Back to cited text no. 29
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Bacteriological quality of Nono, a milk product sold at retail outlets in Federal Capital Territory, Nigeria
George Onyemauwa Uzoaga,Chukwuma David Umeokonkwo,Aishat Bukola Usman,Grace Sabo Kia,Emmanuel Chukwudi Okolocha
Journal of Interventional Epidemiology and Public Health. 2020; 3(2)
[Pubmed] | [DOI]
2 The pattern of abnormalities on sperm analysis: A study of 1186 infertile male in Yasmin IVF clinic Jakarta
S N Aulia,S W Lestari,G Pratama,A K Harzief,K Sumapraja,A Hestiantoro,B Wiweko
Journal of Physics: Conference Series. 2017; 884: 012138
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and me...
   Results
   Discussion
   Acknowledgments
    References
    Article Tables

 Article Access Statistics
    Viewed6667    
    Printed60    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    
    Cited by others 2    

Recommend this journal