A B C D E F G H I J K L M N O P R S T U V W

INFERTILITY (MALE)

What is Infertility ?

Sperms are normally produced in large numbers in the testes, and are stored in a system of coiled tubes behind the testes, called the epididymis. They then pass through a tube (the vas) towards the urethra, the tube which conducts the fluid and sperms (semen) through to the tip of the penis at the time of ejaculation. The same urethra is used to transfer urine from the bladder through the tip of the penis at the time of urination. It takes about 3 months from the time the sperm are made, to the point at which they are released by ejaculation. In order to fertilize the partner's egg, the sperms which are deposited in the vagina need to penetrate the neck of the womb and pass up the cavity of the womb to meet the egg (ovum) which has been previously released from the ovary. In fact, in a normal ejaculation, up to 100 million sperms or more are released! A male is infertile when there is not only a problem of quantity, but also of quality of sperms: they need to be able to swim of their own accord to meet the partner's egg, and then be healthy enough to fertilize the egg when they meet it. The fact that only one sperm is needed to fertilize the partner's egg means that for infertility to occur, there is often an additional major or minor defect on the partner's side as well.

How does Infertility occur ?

Infertility seems to be increasing world-wide, and now affects about one in every 10 couples. This suggests some, as yet unidentified, factor in the environment. At a more personal level, smoking, alcohol and higher than normal temperature surrounding the testicles have all been shown to have undesirable effects on the sperm count and quality. Some people have an apparently inborn abnormality which prevents the adequate production of normal sperm. Patients who have had a testis which did not descend into the scrotum in childhood (whether or not treated by surgery) have a higher risk of infertility. Exposure to x-rays and a variety of drugs can all produce infertility, and these effects are often not capable of being reversed. Infections of the testes and epididymis can also produce infertility, of which mumps particularly in adolescence is a well known example. Any severe or chronic illness can reduce the sperm count and it may take 3 to 6 months after recovery before the count returns to normal. Previous operations on the testicles or groin may have caused an obstruction to the vas or its connections, and varicose veins of the testicle may also produce infertility in some people. Finally, some hormone deficiency disorders can result in poor sperms and semen.

Treatment Involved for Infertility

The doctor will identify from a semen sample whether the sperms are active and present in sufficient numbers (usually 8 to 17 million present in one millilitre of semen). It will be necessary to sometimes check that male hormone levels are normal, and if not, a male hormone injection may need to be given every 2 to 4 weeks. At the same time, the reason for the low male hormone level must be found. In all cases, stopping smoking and a drastic reduction of a high alcohol intake are advisable. If there are no sperm in the semen and the hormone levels in the blood are normal, the doctor may want to look for an obstruction in the tube system. This is especially the case if there has been previous surgery to that part of the body. An exploration of the scrotal sac is performed under general anaesthesia. The surgeon (urologist) will take specimens from the testicles and will look for obstruction which may require an x-ray to be performed (a vasogram). Sometimes an operation to bypass a blockage of the vas can be performed at the same time. A varicocele can be felt by the doctor as a separate lumpy swelling near the testicle. Since it may produce infertility by raising the temperature around the testicle, removing the varicocele by operation sometimes restores fertility. It requires only a single sperm to fertilize an egg. Using the procedure of intracytoplasmic sperm injection (ICSI), it may be possible to salvage even one sperm by passing a needle into the epidydiymis (which stores the sperms). Providing this sperm is of proper quality, it can be directly injected into the partners egg, removed by one of the current methods. Some men produce a protein called an antibody which (like a built-in vaccine) stops the sperms from working properly. In some men with anti-sperm antibodies, using the anti-inflammation drug cortisone can sometimes restore fertility by stopping the antibody from being formed or reacting with the sperms. Other hormone preparations have been used from time to time, but are only rarely successful.

During Treatment for Infertility

Overall, the treatment of male infertility has a low success rate. Probably only one in five infertile men will succeed in producing a pregnancy as a result of medical advice and treatment, but often the female partner is also found to have a minor or major fertility problem as well. Both partners are normally very carefully investigated, even if one partner appears to have the major problem. If any bypass operation has been performed, sexual intercourse should be avoided for four weeks.

Effects on Family of Infertility

The female partner should always be checked for her own fertility by a gynaecologist, despite an apparent problem in her partner. It can be a tense time, with a lot of waiting involved. After any treatment, it takes up to 3 to 4 months before the mature sperms appear in the semen, even if successful. Sometimes the results of tests will show that no further treatment is possible. Because of the overall poor prospects, it may then be useful to discuss the options of artificial insemination and even adoption as possible alternatives.