INFERTILITY IN MEN

The human male, starting at puberty, makes many millions of sperm a day for the next 50 years or more. The human female, on the other hand, is born with about a million eggs, all that she will ever have. Beginning with the onset of menstruation in adolescence and continuing until menopause, a woman's hormones prepare one or two of these eggs for possible fertilization each month. Biology, it would seem, generously equips both sexes for parenthood. Yet, roughly one of every 12 American couples that tries to have a baby fails. Sometimes, the problem is simply impatience. Technically, a couple generally isn't termed infertile unless there is still no baby on the way after at least a year of regular intercourse without using any form of birth control. The odds are sharply against conception most of the time. A woman has just a 20 percent to 35 percent chance of conceiving during each menstrual cycle, even at the peak of her fertility, and that starts to decline slightly in her late 20s and early 30s and more steeply after about age 35.For the many members of the baby boom generation in particular who are late in trying to start families, getting pregnant is not necessarily easy.

The other variable in the childbearing equation is male fertility, which, like female fertility, declines with age, although more slowly. Fertility is impaired in as many men as women. More specifically, the problem lies entirely with the man in about a third of infertile couples and entirely with the woman in about another third.In another group of such couples (some 15 percent to 20 percent of the total) the fertility of both the man and the woman is below par. There are, also, couples in whom nothing can be found in either partner to explain the reproductive difficulty. Would-be parents can therefore avoid a lot of heartache by thinking of infertility as "our" problem rather than "mine" or "yours." Health professionals, too, are coming to recognize the importance of this no-fault philosophy. When a couple is having trouble having a baby and decides to try to do something about it, both partners should be evaluated.

Infertility Tests
A semen analysis is almost always the first test done on men and is usually repeated several times. After abstaining from intercourse for about 48 hours, the man collects a sperm sample in a container. The sample is microscopically examined to determine the number, activity and shape of individual spermatozoa (sperm cells) and the characteristics of the fluid part of the semen. A healthy, potent ejaculate typically contains 1.5 cubic centimeters to 5 cubic centimeters (5 cc = 1 teaspoon) of semen and each cc will contain an average of 70 million sperm that look to be of normal size, shape and behavior. If the specimen markedly differs on any of these factors, further tests may be recommended to determine whether infection, hormonal imbalance, or another problem could be the cause. Among the tests may be a testicular biopsy (performed with a local) in which a small amount of tissue from the testes is removed for laboratory studies.Since even men with sperm counts well below 70 million per cubic centimeter sometimes father children, this test is ordinarily done only when the count is very low. If damage to one or both of the vas deferens is known or suspected, an X-ray examination may also be suggested. As an iodine-containing solution has to be injected into the tubes to make them visible on X-rays. If the examination discloses damage, surgical repairs are often attempted at the same time the diagnosis is made.

Other Special Tests
Other special tests may be recommended if none of the tests already mentioned seems to explain the man's infertility. The most common of these tests are the bovine mucus test and the hamster-oocyte penetration test. In the first, bovine (cow) mucus (from the cervix, or neck of the uterus where it opens into the vagina) is placed in a special glass column. Samples of the man's semen are applied to the column, and measurements are made of how well the sperm are able to enter and swim through the mucus, giving some indication of their ability to swim through human cervical mucus. In the hamster-oocyte penetration test, some of the man's semen is mixed with hamster egg cells that have had their outer shells (membranes) removed. If the sperm are functioning normally, they will penetrate the hamster eggs, an indication that they are also capable of fertilizing human eggs. However, failure of the sperm to penetrate the hamster eggs does not always mean that they are incapable of fertilizing human eggs.

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Nana Kankam