The results of treatment ofin the male are usually unsatisfactory, except when there is an obstruction in the sperm passageways, in which case surgical correction may be beneficial. There are, however, a number of remedies that may work for particular individuals. If the man is not producing enough viable sperm, he may be asked to try losing weight or wearing loose underwear for a time. Sperm production – spermatogenesis – can function properly only when the man’s testes are at a temperature below that of the body. Wearing tight trousers or underpants can increase the temperature and therefore, can have adverse effects, as can frequent, long, hot baths. Some doctors have used a variety of substances – clomiphene (a ‘fertility drug’) or human gonadotropin – on men, with inconclusive results. Testosterone is also used occasionally, which acts to suppress spermatogenesis, and it is thought that by using and then withdrawing this treatment, the testes are stimulated to greater production of sperm. Again, however, results are inconclusive. In some cases, a blockage may be preventing sperm from reaching the urethra and a simple operation can correct this. However, in many cases where sperm have been held back from ejaculation and reabsorbed into the body for some time, antibodies have developed so that even when the pathway is cleared, the man’s immune system* will continue to destroy his own sperm.
In some cases the man does have a certain amount of viable sperm, and his chances of impregnating his partner may be increased by ‘washing’ a sample. In this process, live sperm are separated from dead and damaged sperm and used in artificial insemination. When the woman is ovulating, a sample of viable sperm is placed in a syringe connected by a tube to a small diaphragm. The woman inserts the diaphragm and lies with her hips raised slightly as the sample is flushed gently into her womb, as it would be in normal intercourse.
If, however, the woman is fertile and the man unable to produce viable sperm, some couples are happy to accept artificial insemination by donor (AID). In this procedure, the woman is inseminated with a sperm from an anonymous donor. The doctor will ensure that the donor isy and free from any genetic disease. The donor will be matched, as far as is possible, to the woman’s husband in details such as height, age, skin and eye colour, build and intelligence. In most cases, donors are university or medical students, or partners of women attending the hospital for other reasons and who have already proved their fertility by having fathered a y baby. Just as with normal insemination, several treatments may be needed before pregnancy occurs. In about two-thirds of the cases insemination is necessary for three consecutive months before success is obtained. In cases where the husband has some fertile sperm, it is possible to mix this sperm with that of a donor in order to give the couple at least some chance of conceiving as a result of the husband’s sperm.