How is male infertility diagnosed?

The first stage is a fertility test. The patient has to produce a sample of semen for examination under a microscope. Because frequent ejaculation can reduce the sperm count and the volume of sperms, the patient is required to abstain from intercourse for at least three days before providing the sample. Ideally the sample should be produced by hand (masturbation). The seminal specimen has to reach the laboratory within two to three hours, otherwise it begins to deteriorate.

Its volume is measured (the average is 3.5 ml-about a teaspoonful) and the number of sperms in the sample are counted on a specially ruled slide under the microscope. The shape of the sperms is also examined and the proportion of normal and abnormal sperms noted. Normal fertility probably requires not less than 20 to 30 million sperms per millilitre of fluid, but preg-nancies can take place with a much lower count However, there’s litde chance below one million per millilitre. Some 60 per cent of the sperms should be swimming briskly during the first two to three hours after ejaculation; if they begin to slow down rapidly this seriously reduces the chance of a pregnancy. It’s possible for a man to have up to 30 per cent of abnormal sperm in his sample without his fertility being affected.

In some men the quality of their semen varies considerably from one ejaculation to another, so in some cases the fertility test has to be repeated.

If the semen test shows the patient’s sperms to be normal the doctor will then check the patient’s state of health and his genital organs to make sure there are no problems there. He will also ask about the frequency of intercourse. If the patient and his partner are not making love during the vital couple of days of his wife’s midcycle (when she’s ovulating) then this lessens her chance of conceiving. Conversely, if the man’s sperm count is already on the low side and the couple make love too often in the few days before ovulation, the frequent ejaculations will adversely affect the quantity of his sperms.

When can an operation help?

When it’s suspected that an obstruction of one of the ducts may be the cause of infertility, the doctor may suggest a surgical exploration of the testicles to establish where exactly the blockage has occurred.

If there is a blockage in the vas deferens, for example, it may be possible to short circuit it through an operation called zvaso-epididymostomy. This involves by-passing the blockage by joining the head of the epididymus to the vas deferens at a point beyond the blockage.

Where infertility is the result of gonorrhoea there is about a 50 per cent chance that sperms may reappear in the seminal fluid after this operation. Unfortunately, in many of these so-called successful operations the patient’s sperm count remains low – especially if the blockage had been present for a long time- so the chances of his partner conceiving are still not very high.

Where the blockage is due to the defective development of one of the ducts there’s very little chance of curing it through surgery, and blockage due to tuberculosis can’t be cured at all.

A varicocele can be treated through an operation called high ligation, but opinion is divided as to how effective this treatment really is. Results show that the sperm counts improve in 60 to 70 per cent of men receiving this treatment- but it can’t guarantee that the patient will subsequendy father a child. The operation requires considerable skill, and is carried out under general anaesthetic. The patient is in hospital for about four or five days.

Does infertility affect a man’s sex drive?

In most cases, no. The majority of infertile and sterile men have a completely normal and unimpaired desire for sexual relations. They only become aware of their infertility after their semen has been examined. Unfortunately this knowledge sometimes has the psychological effect of making them feel inadequate. This in turn affects their sex drive, and in some cases even makes them impotent, so that they are unable to have an erection or an ejaculation.

But most impotent men can produce semen by masturbation, even if they can’t have full intercourse, and very often their semen is found to be fully fertile. In this instance, the wife could become pregnant through artificial insemination, using the man’s semen. Most men with a defi-ciency in their male hormone secretion do lack sex drive. In many cases their interest in sex can be fully restored through hormone therapy.