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Health » Sexual-health » Male-virility-061016
 
Adam's agony
Deconstructing male virility, sexuality, fertility

Dr. Aniruddha Malpani Dr. Aniruddha Malpani
Renowned infertility specialist. He runs an infertility clinic in Mumbai and has written many books.

Adam's agony Fatherhood has always been important in Indian society, but male infertility is surprisingly common. 1 in 6 couples is infertile, and in 50% of these, the problem is with the man. To put this in perspective, remember when you are watching the Indian cricket team playing the next time, that at least one of the men on the field is likely to have a fertility problem, whether they know it or not!

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Most young men are obsessed with their virility, but few worry about their fertility. Most Indian men still believe that making babies is a woman's job, and expect that if they can have sex, they can also get their wives pregnant. However, this is simply not true! While it is true that you need to be able to perform sexually in order to get your wife (or girl friend) pregnant, this is not enough! You also need to have enough active sperm in your semen to be able to fertilise her eggs, and there is no relationship between your sperm count and anything else - your sexuality, virility, your performance in the bed, or the size of your penis. What this effectively means is that you can never be sure of your fertility - until you have actually got your wife pregnant!

Some men may suspect they have a fertility problem. Thus, men who have low levels of testosterone (poorly developed secondary sexual characters; an effeminate appearance; scanty hair; decreased libido) may have a fertility problem; as may men whose testes are small or absent. Men who have had testicular inflammation (a swollen and painful swelling of the testis called orchitis) after an attack of mumps; and those whose testes have been injured are also at risk for infertility. Children who have had hernia surgery in childhood are also at risk; as are young men who have chemotherapy for treating leukemia and lymphoma. Men who have erectile dysfunction may also need infertility treatment; as may those with diseases such as diabetes, which cause them to have problems with ejaculating semen properly.

Isn't there a test for measuring male fertility?
The basic test is a semen analysis, which allows the doctor to measure the number of sperm (sperm count) you have, how active they are (motility) and whether they look normal (morphology). However, while it is true that a man with no sperm (a condition called azoospermia) cannot get his wife pregnant, many men (and even many doctors) still do not appreciate the limitations of the semen analysis. After all, the sperm count is not like a bank account, and the key question is not - What is the sperm count, or motility ? They key question is - are the sperm capable of working? Are they capable of fertilizing the egg? And there really is still no test which can answer this reliably for the individual man. While it is true that men with a low sperm count have lower fertility, there are also men with an absolutely perfect sperm count who cannot get their wives pregnant, because their sperm do not work properly - in effect, they are shooting "blanks".

What if the sperm count is zero?
This is called azoospermia, and requires evaluation by a specialist, so that the doctor can determine if the problem is a result of the failure of the testes to produce sperm properly; or if the passageway is blocked or absent.

Men with a low sperm count present the most frustrating problem in reproductive medicine today. This condition is called oligoasthenospermia (low sperm count with weak sperm) and in the vast majority of cases, we simply cannot determine what the reason for the low sperm count is. This is labeled as being idiopathic, which is just a Latin term to disguise our ignorance (or as my patient poetically phrased it, means that the doctor is an idiot and the condition of the man is pathetic!) In many cases, we are now learning that the reason for the low sperm count is genetic, and is due to a microdeletion on the Y-chromosome. These men typically have a very low sperm count, because some of the genes on their Y-chromosome which code for sperm production are absent. Since we cannot determine the reason for the low sperm count in many men, it is hardly surprising that we have very little effective therapy to offer them. This is the reason why there are hundreds of medicines to treat men with low sperm counts - because none of them work! We do know that a low sperm count is not related to physique, general state of health, diet, sexual appetite or frequency. While not knowing the cause can be very frustrating, medicine still has a lot to study and understand about male infertility, which is a relatively neglected field today.


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