Life & Work

Help, I think I am infertile!

EAfertility2

A couple is considered to have infertility issues when they try to conceive for a year without success. PHOTO | FILE

Q: My wife and I have been trying to have a baby for the past five years. Initially, we thought that the problem was that my wife had used contraception for many years and we hoped that once the medication had ‘left her body’, we would be able to conceive.

We visited her gynaecologist who informed us that the oral contraceptive pills my wife had been using were not the cause of our problems. She then suggested that we both get tested for possible causes of infertility. My wife has undergone a battery of tests and scans all of which show that there is nothing wrong with her. It seems that I am likely to be the cause of our infertility.

I was meant to go for a full physical examination and a semen analysis, but so far I have found excuses not to go. I cannot bear the thought that I might be infertile. I feel like I have disappointed my wife and my parents (I am the only child and my parents desperately want a grandchild).

My wife and I no longer get along since she thinks I am being cruel to her by refusing to go to the doctor.

For the past one year, I have tried all sorts of over the counter infertility treatments including Chinese herbs and male stamina drinks and pills but nothing seems to work.

Is there anything else I can try? Should I maybe change my diet or stop drinking?

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The first thing you need to do is to stop using over-the-counter ‘fertility’ medication. It can be very harmful to your health (even those that pride themselves on being ‘natural’). Most of these drugs have not been proven to be useful in curing infertility.

Some of them are laced with testosterone like chemicals and medication normally used to treat erectile dysfunction all of which may heighten your sexual arousal and excitement but they do not address your infertility. Avoid them at all costs.

Now, you need to realise that some couples have a hard time getting pregnant (about 10 per cent of all couples). A couple is considered to have infertility issues when they try to conceive for a year without success.

For the longest time people thought that was only a woman’s problem. Truth is, it’s estimated that in about 1 out of 3 times it’s due to a problem with the man’s fertility.

Causes of Male Infertility

Sperm abnormalities

More than 90 per cent of male infertility cases are related to sperm problems. These include:

Low sperm count and azoospermia: A sperm count of less than 20 million/mL is considered low sperm. I know that sounds ridiculous but very few sperm actually survive after you ejaculate (hence the very large numbers that are released each time one ejaculates). Azoospermia refers to the complete absence of sperm cells in the ejaculate.

Poor sperm motility (ability to move): If sperms move too slowly or not in a straight line, they may have difficulty navigating the female genital tract and penetrating the egg.

Abnormal sperm shape and structure: The perfect sperm structure is an oval head and long tail. Abnormally shaped sperm cannot fertilize an egg.

Low semen volume: Two millilitres (ml) of semen is considered normal. A lower amount may indicate a problem with blocked tubes or issues with the prostate gland.

Premature ejaculation

This is uncontrolled ejaculation either before or shortly after sexual penetration. It happens with minimal sexual stimulation and before the person wishes. This can pose a challenge when trying to conceive, especially if the man keeps ejaculating outside the vagina.

‘Reverse’ (Retrograde) ejaculation

During normal ejaculation, semen travels in a forward direction out of your penis. In retrograde ejaculation, orgasm causes the semen to be forced backwards into the bladder. This abnormal ejaculation can occur after surgery to the bladder or prostate and spinal injury/surgery.

Use of certain medication (such as those used to manage prostate problems, some anti-psychotics and some anti-hypertensives) may cause temporary ejaculation problems. Men with diseases that destroy their nerve function such as multiple sclerosis and poorly controlled diabetes can have ejaculation problems as well.

Genital defects

These include undescended testes, blockage in the tubes that transport sperm/semen and abnormally opening urethras (if it opens on the top or bottom of the penis instead of at the tip). Tube blockage can be congenital (as in you are born with it) or it can occur after severe or recurrent infections. Common genetic disorders that can affect the male reproductive system include cystic fibrosis and polycystic kidneys.

Hormonal imbalance

Low levels of male reproductive hormones can affect your fertility especially if the deficiencies are very severe.

Aging

Although men have been known to father children in their 90s, aging can reduce sperm count and motility and has been known to decrease the genetic quality of the sperm produced.

Substance abuse and alcoholism

Use of illicit drugs and exposing your body to chemical toxins has been known to affect fertility. Alcoholism can significantly affect your sexual, mental and social function and has been linked to infertility.

Radiation

Exposure of the genitals to radiation (especially high doses) can damage testicular tissue leading to fertility problems. Radiation therapy (radiotherapy) is a common treatment in cancer patients. For this reason, some cancer centres ask male patients to store some sperm in a bank before they get radiation therapy.

Now, the only way to find out whether you have a problem is to go have yourself examined by your doctor. It is often easier to get the initial assessment by your wife’s doctor. In order to treat you effectively, the doctor will take a very detailed sexual history from you.

Do not feel embarrassed about questions about your sexual performance, past sexual experience and sexually transmitted infections –remember, it is important to be honest! She will then examine you fully.

After this, you will be asked to give a semen specimen for assessment in the lab (to look for any possible sperm abnormalities). She may decide to do hormonal levels and even imaging of your reproductive system to check for any abnormalities. In some rare cases, genetic tests may be done.

Your treatment will depend on the underlying problem. If there are any problems identified your wife’s gynecologist will either manage them herself or refer them to the different doctor who can (for example, if the problem is with genital defects such as tube blockages, you will be referred to a urologist and if you have hormonal problems you will be referred to an endocrinologist who will start you on medication).

In some cases, you may need the help of a fertility centre where your sperm can be harvested, then your wife’s egg can be fertilised in the lab after which it is implanted in her uterus. It is also not in your best interest to drink heavily when trying to conceive but there is no evidence to prove that changing your diet will improve your fertility.

Now, infertility is a couple’s problem and must always be handled as such. Men often try and tackle problems alone but in this case you must involve your wife. Ask her to accompany you to the clinic and let her understand that you are keen on becoming a father.

This will go a long way in easing the tension between the two of you. If need be, enrol the help of a marriage counsellor.