Infertility is best described as the inability to conceive after one year of sexual intercourse without the use of any contraception. According to Dr Paul le Roux, a Cape Town-based reproductive specialist, about 15% of all couples trying to conceive have infertility problems, and in about 40% of these cases, the difficulty may lie with the male in the relationship. “In most cases the exact cause of infertility is unknown, but there has been some evidence to suggest that environmental chemicals may reduce sperm function, such as estrogens in the environment and even certain pesticides,” says Dr le Roux.
He goes onto say that the most well-known causes of male infertility are caused by damage to the testicles from infections like mumps, genetic problems, failure of the testicles to properly descend, damage caused by chemotherapy and radiation, or the loss of a testicle from torsion or trauma. Further complications include the fact that the tube from the testicles carrying sperm, may also be blocked from a sexually transmitted group of infections, and in some cases, men are actually born without the vas deferens tube.
Dr le Roux adds that it’s important not to discount the effect that increased stress levels associated with a busy lifestyle can have on infertility in both men and women. “This often leads to marital problems and decreased frequency of sexual intercourse. Also while a couple is struggling to conceive a child, it often places enormous pressure on their relationship, and having adequate emotional support from psychologists, family, and friends is important.”
He says that the most important factor to consider before undergoing the fertility treatment process is to have a strong support system. If it’s a couple trying to conceive, they need to be very supportive of each other as well, because this process can put a relationship under a lot of pressure. Dr Mandy Rodrigues, a clinical psychologist, specialising in fertility treatment agrees: “A fertility counsellor can play a very important role in helping individuals and couples deal with the emotional and psychological impact of fertility treatment,” she says.
According to Dr le Roux, stress can also lead to sexual problems such as impotence and failure to ejaculate. But there is no evidence to suggest that stress reduces sperm count in men. The link between stress and infertility is also very prevalent in women, but most of the time there is a biological reason why the couple has failed to conceive. “Lifestyle can also impact fertility where excess use of alcohol and heavy smoking reduce sperm function,” he says. “It’s also been shown that wearing tight underwear can also reduce sperm function, the reason being an increase in temperature. Testicles are designed to produce sperm at a temperature below 37 degrees which is why they hang away from the body in the scrotal sac. If they are pulled up and heated a degree higher, this may affect sperm function.”
Couples seeking fertility advice would typically visit a reputable fertility clinic where both partners would be thoroughly evaluated. Men usually undergo a semen analysis to evaluate the sperm function. Sometimes a urologist may also be consulted if there is a suspected physical abnormality of the penis or testes that needs surgery. “A semen analysis is a basic test of male fertility. A semen analysis is not invasive. A sample container is given to the patient who can complete a sample at home and bring it straight through to the clinic for assessment,” says Dr le Roux. There are many parameters checked in the semen analysis but the most important are: the sperm count (number of sperm in the sample), the motility (movement of the sperm) and the morphology (shape of the sperm). This test helps the fertility specialist decide if a simple treatment like artificial insemination of the sperm may be effective, or in more severe cases in vitro fertilization is needed.
To have a spontaneous conception the sperm count should typically be more than 10 million/ml, and the sperm motility should be more than 40%. The morphology is very important and there should be more than 4% perfectly shaped sperm in the sample. In rare cases, some men have no viable sperm in their ejaculated sample and the specialist may need to proceed with a testicular biopsy procedure to extract a small amount of tissue from one testicle, which can be used to fertilize the egg.
“Infertility means a couple has not conceived for one year,” says Dr le Roux. “However, it doesn’t mean that it is impossible to have a child. The word ‘sterility’ usually means there is no viable sperm at all in the ejaculated sample. Some men will also have no viable sperm in the testicle and therefore may choose to use an anonymous sperm donor’s sperm from a sperm bank. This may also be an option for couples who cannot afford the cost of the in vitro fertilization procedure,” says Dr le Roux. “The most important thing to remember is not to panic, couples trying to conceive, must consult a reproductive clinic to receive a holistic treatment plan and properly evaluate their options,” he concluded.