Every so often, a man will attend my practice because he believes that he is infertile. Sometimes he would tell me of a previous relationship where his partner was unable to conceive but that this same partner was able to conceive when she entered a new relationship. In agony, he would explain that after, say, about two years in his present relationship, his partner is still unable to conceive. Then would come the question, "Doc, why can't I father a child?"
Limited information
The man is responsible for infertility in about 30 to 40 per cent of couples who are unable to conceive. Unfortunately, there is much more information about female than male infertility. Men are often embarrassed or too depressed about the condition to discuss it with their physicians. However, infertility is a physical problem that can wreak emotional havoc on the man and his marriage. He can address this condition by obtaining as much information as is available.
Main cause
The main cause of male-factor infertility is failure to produce quality semen. The semen has few or no spermatozoa. A semen test or analysis will determine the quality of the semen. The World Health Organisation (1992) established guidelines for determining a satisfactory semen test. These are:
Volume greater than 2ml.
Ssperm density greater than 20 million/ml.
Motility greater than 50 per cent with forward progression.
Morphology greater than 30 per cent normal.
Viability greater than 75 per cent live.
White blood cells 1 million/ml.
It is accepted that if a man has a sperm density (also called sperm count) of less than five million, fertilisation is very unlikely to occur. If a man's sperm are too slow or too weak because of malformations, the chances of fertilisation are very low.
Other causes of infertility
Mumps after puberty can cause destruction of the seminiferous tubules which make sperms. Sexually transmitted infections can result in blockage of the tubes which transport sperms, thus preventing sperm from forming part of the ejaculated semen. It is known that fever for a prolonged period may depress the synthesis of sperms for several weeks but recovery occurs when the fever resolves.
Drugs such as alcohol, ganja (marijuana) and even tobacco can cause infertility. Drugs used in chemotherapy and radiotherapy are well-known agents leading to infertility. Steroids, antobiotics and some drugs used to treat epilepsy can cause infertility.
A low number of sperm may be due to low levels of pituitary or testicular hormones. Men who have never been fertile should be tested for low or absent gonodatrophin hormones. This condition can arise in men who were previously fertile if they have suffered certain trauma, tumours or radiation therapy. In these cases, the condition can be treated by gonodatrophin replacement therapy.
About half of infertile men will not be able to identify the cause of the problem. This can be frustrating but allows the man to determine his prognosis.
After an accurate diagnosis is made, the man will be told whether his condition is amenable to treatment. His physician will refer him to a fertility centre for further care.
Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: yourhealth@gleanerjm.com.