Infertile men in Trinidad and Tobago

Newsday continues its look into low fertility rates in Trinidad and Tobago with fertility expert Dr Catherine Minto-Bain. The previous article published on May 13 gives an overview and thoughts by gynaecologist Dr Sherene Kalloo.

Minto-Bain's interview raised the need for examination and urgent action into the environmental causes of infertility in the country and region.

Even as a Sahara dust obscured Trinidad and Tobago’s sky on May 7, fertility and reproductive specialist Dr Catherine Minto-Bain worried about how the poor air quality would affect those trying to have children.

Often discussions about infertility and low fertility rates tend to be female-skewed and personal, the medical director at the Trinidad and Tobago IVF and Fertility Centre said there are growing environmental and social issues to consider.

In a phone interview about Trinidad and Tobago's low fertility rate, Minto-Bain said, “It is something that is now beginning to concern governments because they are beginning to see the economic impact of having less children being born in your country.”

While Trinidad and Tobago was not unusual, and the issue has been around for more than 20 years, the fertility rate was dropping again.

“We are well below replacement rate now. So the average woman in Trinidad and Tobago's fertility rate is 1.6. So if a woman is not having two children, she is not replacing the population,” she said.

At the clinic, Minto-Bain and other staff often saw two things in the patient population coming to them: people coming at a later age and those who did want children at all.

She also runs the Caribbean Egg Bank and for the last 20 years has had eggs donated by “young, healthy women” in their early 20s and mid-20s.

“I have been doing this now for 15 years and when you talk to these eggs donors, many more of them are coming through saying, ‘I am not going to have children.’

“And that is not something we really saw even very much say five years ago and I can’t say I heard it ten years ago.”

She said ten years ago people would have come in saying they completed their family and would like to help someone else.

The reasons for this were quite varied.

“The reasons are: ‘I’d like to travel,’ ‘I’m not sure that I want to choose a partner for life,’ ‘I’m worried about the climate, the environment.’”

Other reasons were people did not like how they were parented and were uncertain about being good parents themselves.

“The Gen Z generation (people born from 1997-2011) have a very different outlook on having children…,” she said.

Minto-Bain said some women had fertility treatments, wanted another baby but could not afford childcare or take more time off of work.

She said there were a lot of financial considerations and many of the clinic’s patients were choosing to only have one child, Minto-Bain added. There was a 2011 TTIVF study into male fertility in TT.

A 2018 audit by the clinic supported the 2011 findings which found male infertility was high in the country and region and there were a number of contributing factors such as diet, smoking, alcohol intake etc.

The study looked at the causes of infertility among people coming through their clinic in the last ten years.

It found that the causes were fairly evenly divided with a third male to a third female causes and a third was both.

It also found that in TT, half of couples had more than one problem.

“When we looked at about 10,000 people had been through the clinic, the male factor hit the top, it was the number one spot. More men coming in to the fertility clinic in TT had no sperm in their ejaculate or a very low sperm count compared to what you would see in fertility clinics abroad,” she said.

She said the male factor seemed to be more of a problem in TT and other Caribbean countries saw similar data.

A 2023 World Health Organization (WHO) report said one in six people in their lifetime would face infertility, she said.

“Obviously, what we eat is not as good as it was 50 years ago. Obesity is much higher and that affects fertility. We probably drink more alcohol, sleep, smoking…”

Apart from these, Minto-Bain said environmental factors including climate change were growing, critical factors.

Fertility declined with worsening air pollution, she said.

Many people were unaware of the environmental issues that affected fertility.

“Those particles in the air they get into your blood stream. They cause damage to genetics; they cause inflammation and oxidative stress. They are really bad for you,” Minto-Bain said.

She wished there was more governmental emphasis on environmental problems and infertility.

Climate change was affecting fertility already and was not being shouted loudly enough.

“We see the wildfires, we see the erosion, the flooding but do we think about its effects on our ability to have children and miscarriage rates.

“I wish the governments would take more of a part in informing the population,” she said.

This provided a good opportunity for good governments and insurance companies to come in and provide information and monetary support for people who want to have children.

She said there were hundreds of couples on the clinic’s list who wanted IVF but were struggling to find the money for it.

Minto-Bain said she wished TT’s healthcare system would see fertility as a priority.

“We should have fertility clinics in the public sector for men and women with up-to-date protocols that people get really good care.”

Asked what can be done to slow the declining fertility rate and how soon should societies respond, Minto-Bain said governments needed to act now as the problem was already here.

She said there needed to be public education campaigns in schools teaching children about good food and nutrition and how to avoid toxins and poisons in the body.

These would assist in not only higher fertility but less obesity and cancers, she said.

She also called for free fertility clinics in the public health sector.

“If you want to increase your population and get more babies, support women in getting back to work, support women with better child care, make childcare facilities free for women going back to work…,” she said.

She said among Gen-Z’s, while there are some extreme views, many did not see a woman’s place as being in the home or it being necessary to increased fertility rates. Gender was fluid for them and they had a different perspective, she said.

Minto-Bain also said views that LGBTQI+ couples contributed to low fertility rates were untrue as many of these couples were having families.

She said fertility was a big issue in TT as developing countries had worst infertility rates than first-world countries.

“And if you’re thinking that obesity, poor healthcare, poor nutrition, climate change and poor air quality affect your fertility you are beginning to understand why.

“I would say that the causes for infertility – particularly the massive male fertility problem we have in the Caribbean – are extremely poorly understood and it is probably because it is relating to a lot of issue like inflammation in the body and damaging things in the body.

“It is not as simple as a pill is going to fix it,” she added.

The region needed to understand this was a big issue and there is help in fertility clinics, she said.

Minto-Bain said insurance companies should help the public as infertility was a medical condition and should be covered so people could get the tests to find out why they were infertile.

“People who want to have children, who would make brilliant parents often, just can’t have their children for a variety of reasons.

“To get them the support and to get them the treatment they want, that would be one of the most amazing things the Government could do to boost the economy and to lift the mental health and wellness of our population.

“It would be amazing to see that in TT,” she said.