Infertility
in the male is not the same as impotence ( see Impotence) although
the two may be associated. Infertility results from the inability
to produce sufficient, normal spermatozoa, that will induce
pregnancy in a woman under normal conditions. A normal ejaculate
should consist of between 2 and 5 mls of semen. The semen can
be examined microscopically for number of sperm, their physical
structure and their mobility. The minimum number of sperm for
fertility is probably above 20 million per ml. of semen. 60
million per ml., or above, is to be preferred. The majority
of the sperm should be of normal configuration and mobility.
In the worst case (azospermia) there are no sperm at all, although
the semen may look normal to the naked eye. In recent years,
the average sperm count of men in Western Europe has fallen
markedly. The cause is not known. Male infertility results either
from failure to produce adequate, normal sperm in the testes
(as may occur following damage by the mumps virus, or radiation,
or chemotherapy) or because there is physical blockage between
the testicle and the male urethra, usually in the tube known
as the vas deferens, so that the sperms cannot get out. This
may occur deliberately as a result of vasectomy (where the vas
is cut), or the vas may be abnormal or damaged, or there may
be abnormal blood vessels (varicocele) hindering the passage
of sperm. Sometimes the body produces antibodies against its
own sperm. Sometimes the sperms look normal but the heads of
the sperms (acrosomes), designed to enable penetration of the material around the ovum, do not work as they should, when confronted with the ovum.
Lower than normal sperm counts are often found in men who have normal sperm counts at other times.. For this reason, abnormal sperm counts should always be repeated at least once. Azospermia requires investigation by a urologist who specialises in this area and may require biopsy of the testicle to see whether or not, sperm are being produced. Simple measures to improve fertility may be tried. Testes are sensitive to heat and trauma, so the old adages like wearing loose underpants and not going for long rides on a hard bicycle saddle are worth following. Blocked vas deferens can be repaired surgically with fair results (often done for men who have had a vasectomy in the past, but now want to have a child with a new partner). Operation for varicocele very often produces good results. More sophisticated investigations are now available including tests to see whether the acrosome is functioning normally. In low sperm counts, various hormonal treatments, including testosterone, are tried. |