Semen Profile Of Male Patients Attending Urology Clinic For Infertility: Analysis Of Laboratory Records At Surgical Research Laboratory, Ibadan, Nigeria.

Abstract

Infertility is a disease of male or female reproductive system and is one of the major public health problems. Male infertility is the inability to impregnate a woman after 12 months of regular, unprotected sexual intercourse. Male factor is reported to be the cause of about 40- 50% of cases of infertility worldwide. Deficiencies in semen due to many factors such as environmental, genetics, hormonal, infections etc have been strong indicators of infertility in males. However, in Nigeria there is a dearth of systematic evidence on the semen profiles of already infertile men. Thus, this research aims to investigate the semen profile of adult male patients attending urology clinic for infertility. A retrospective record review was conducted on 286 male patients aged between 18 and 65 years. A multi-stage sampling method was employed. The first stage involved was the purposive selection of both the urology clinic and the surgical research laboratory. In the second stage, laboratory registers were screened for eligibility and registers covering September 2016 – August 2018 were selected. Patients’ results in the selected registers were screened for inclusion criteria, sampling interval was calculated and simple random sampling was performed. Simple tabulations and cross tabulations were done to determine proportions. Associations were tested with chi-squared, or Fisher’s exact tests and significance was tested at the 5% level. Out of 286 patients reviewed, 159 (55.6%) of the patients had never achieved pregnancy (primary infertility) and 127 (44.4%) had at least achieved one prior pregnancy (secondary infertility). We found that the enlargement of the veins that hold the testicles (varicocele) accounted for 141 (49.3%) cases of infertility and it was responsible for 79 (27.6%) of primary and 62 (21.7%) of secondary infertility. Inability to keep/sustain erection (erectile dysfunction) was second accounting for 42 (14.7%) while physical injury (trauma) to the testicle/scrotum accounted for 39 (13.6%) cases. It was observed that 143 (50.0%) of the patients had low sperm count (oligospermia) in one ejaculate and this accounted for the cause of 79 (34.5%) primary and 64 (28.0%) secondary infertility cases. No/absence of sperm cell (azoospermia) in semen ejaculated was found in 57 (19.9%) patients. The percentage of low quantity of semen (hypospermia) per ejaculate in this study was 22.4% while high quantity of semen (hyperspermia) per ejaculate was 3.2%. In this study, semen with acidic pH was 24 (8.4%), neutral pH was 205 (71.7%) and basic pH was 57 (19.9%). The age of patients ranged from 18 to 64 years with mean age of 38.0 ± 7.6 years and the modal age group was 30-50 years 243 (85.0%). The clinical condition most reported among the patients under review was the enlargement of the veins that hold the testicles (varicocele) which was the most common cause of primary infertility. Low sperm count per ejaculate (oligospermia) was common among the patients during the period under reviewed. More than six out of ten attendees had low sperm count per ejaculate, this was commoner among those who had never achieved pregnancy than those who had at least achieved one prior pregnancy and in more than four of the six, the low sperm cells count was severe. Therefore, this study observed that varicocele, erectile dysfunction, low volume of ejaculate and low sperm count are commonest presentations among males during the period under review and were also strongly associated with infertility in males.