In most cases, when a couple is having problems conceiving, the first person to be blamed is the woman. However, according to health experts, the couple should always endeavour to be screened to find out who has a problem and it could be either party.

Experts further note that because of the lifestyle people are exposed to nowadays, both men and women are at greater risk of developing infertility problems.

A recent study published in the Human Reproduction journal indicates that men with more weight than necessary are at greater risk of infertility, and that such men could suffer low sperm count and poor quality seed, the precursor to infertility.

The study also found that greater body mass index (BMI) was closely associated with measures of lower sperm count and overall poor semen quality.

The collateral damage of overweight and obesity (a BMI above 25 and 30, respectively) should concern men who fall within that range and wish to continue having children, the researchers say.

Experts say obesity is a serious, chronic disease that can have a negative effect on many systems in one’s body. People who are overweight or obese have a much greater risk of developing serious conditions, including; infertility, heart disease, Type 2 diabetes, bone and joint disease, as well as cancers.

According to Dr Everiste Ntaganda, the in-charge of cardiovascular disease at Rwanda Biomedical Centre (RBC), obesity is a risk factor to many health conditions including heart diseases, diabetes and other metabolic diseases and infertility, particularly in men.

He says being overweight/obese is becoming more common in the Rwandan population, especially among well-to-do people living in urban areas.

The Rwanda 2015 Steps Survey shows that 2.7 per cent of the population is obese. Obesity of women in Rwanda is 4.7 per cent against 0.8 percent of men. Prevalence of obesity in urban areas is 10.2 percent.

What leads to male infertility?

Edison Rwagasore, the senior officer, diabetes, chronic diseases and other metabolic diseases RBC, says there is now emerging evidence that male obesity impacts negatively on male reproductive potential, by not only reducing sperm quality, but in particular altering the physical and molecular structure of germ cells in the testes and ultimately mature sperm.

For a man to have better offspring, he says his sperm cell must have quality, quantity, mobility and maturity.

Rwagasore explains that there are many theories that explain this connection.

For instance, he says the greater fat storage can turn testosterone into the female hormone estrogen, leading to slowing of sperm production.

Again, a man being overweight or obese can alter the physical and molecular structure of germ cells in the testes and ultimately mature sperm. On the other hand, Ntaganda says the hormone leptin, which is produced by fat cells might be damaging to sperm cells.

Besides, he points out that fat tissue also causes temperature within the scrotum to rise, which results in killing sperms.

Rwagasore says abnormal sperm production or function can be due to undescended testicles, genetic defects, and health problems such as diabetes or infections such as chlamydia, gonorrhoea, mumps or HIV. Enlarged veins in the testes can as well affect the quality of sperm.

Other possible causes

Infertility in men is defined as the absence of conception after one year of unprotected sexual intercourse.

This, according to Francis Kazungu, a general practitioner in Kigali, has been linked with male obesity that might be caused by the reduction in sperm concentration and mobility, an increase in sperm DNA damage and changes in reproductive hormones.

How to reverse the condition

Some studies have shown that turning the tide back is possible by treating obesity and embracing simple interventions such as changes in diet and exercise.

Kazungu points out that problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs, interferes with fertility in men.

On the other hand, Rwagasore notes that overexposure to certain environmental factors such as pesticides and other chemicals, as well as radiation, are also possible reasons one can develop fertility problems.

"Staying away from smoking, use of alcohol, marijuana and some unprescribed medications such as antibiotics and antihypertensive, among others, is important as it keeps one from developing infertility problems,” says Kazungu.

Rwagasore also says frequent exposure to heat, such as in saunas or hot tubs, can raise the core body temperature and may affect sperm production.

He also notes that avoiding or limiting use of such therapies can prevent problems of infertility.

"Damage related to cancer and its treatment, including radiation or chemotherapy can impair sperm production, sometimes severely,” he says.

What should be done?

Ntaganda says the increasing prevalence of male obesity calls for better public health awareness.

He says this should be with a better understanding of the molecular mechanism involved during spermatogenesis along with the potential of interventions in reversing these deleterious effects.

"Health awareness campaigns should recognise the importance of over-nutrition, as well as under-nutrition, and should promote healthy diets and the importance of physical activity,” Ntaganda adds.

For one to know if they are on the right track, Joseph Mucumbisti, a pediatrician and president of Rwanda Heart Federation, says going for regular checkups is necessary.

"This will help them get screened and their body mass index checked which is vital when it comes to determining the weight of someone. Through this, one can be guided on what to do depending on the results,” he says.

For instance, Mucumbisti explains that a person with a BMI of less than 18.5 is considered as underweight, while BMI greater than or equal to 25.0 fall under those who are overweight. Those with BMI greater than or equal to 30.0 are considered as obese, while normal weight falls in between 18.5 and 24.9.

He adds that sometimes people end up developing problems such as infertility because of lack of enough knowledge, but regular checkups can keep them away from all this.

Mucumbisti says there are remedies and practices that when adhered to can reduce the chances of infertility in men.

For instance, Ntaganda says since high temperatures tend to slow down the sperm factory; therefore, avoiding this is important. He notes that this could include males avoiding or limiting hot baths, among others.

He notes that avoiding testosterone is important as it can also have impact when it comes to men fertility. Focusing on healthy nutrition and having enough sleep is also the way to go as far as maintaining good fertility is concerned.

Additionally, Ntaganda says that as a couple, going for fertility checkups is important, and if found out that one has a problem of infertility that can’t be treated, there are many options which can still help them have children. He says this can prevent them from developing problems such as depression and stress, which could lead to other health complications.

Experts share tips

Emmanuel Ssemwanga, gynecologistOlder people are at a higher risk of getting fertility problems because of age-related factors. This applies to both men and women. In fact, for a woman, her chances to conceive and have a healthy baby start declining in her early 30s.

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Celestine Karangwa, physiotherapist

Although lifestyle factors that interfere with fertility can be treated, people need to be keen when it comes to factors that can be avoided. Being exposed to them can lead to health complications while trying to rectify them.

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Clarisse Umutoniwase, nurse at Clinic Galien in Remera Being underweight can also make a woman delay to conceive, making them think they have a problem of infertility. To avoid this, sticking to a balanced diet and regular checkups is advisable.

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Jean Marie Nsabimana, general practitioner

Avoiding animal products such as dairy milk, beef and pork, which have high fat content, is important. Besides, tight undergarment for men should be avoided as it exposes one to high temperature which affects the quality of sperm produced.