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 "Infertility ... who's got the problem?"

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The following is a question I received via email from a website visitor who happens to be female:

"I am 29 years old, married for five years already, but I havenít been pregnant yet despite the fact that my husband and I have never practiced any form of contraception. My husband said that when a couple fails to have children, the problem is always with the wife. This is what many of my friends also say. Are they right? Do you think itís about time I consult a doctor?"

Your husband and friends are dead wrong. In 30 percent of infertile couples, the problem is in the male alone while in another 20 percent the problem is partly due to the male and partly due to the female. Hence, men are partly or fully accountable for half of all cases of infertility among couples.

After four years of trying to conceive without any success, is it time to see a doctor? Definitely. In fact you should have seen a doctor about your problem three to four years ago. About 85 percent of couples who do not practice any form of contraception have a pregnancy within one year. Couples in which the wife fails to conceive in a yearís time are considered infertile and should seek consultation if they want to increase their chances of having babies. The earlier an infertile couple seeks consultation, the higher are the chances that the couple can ultimately conceive a child.

Go and seek medical consultation soonest. Itís not yet late for you and your husband considering the fact that you are only 29 years old. But when you see a doctor, it is best that your husband is with you not only because he could be the reason for your inability to get pregnant, but also because going through the assessment process together will definitely improve your marital bond.

It is easier to determine infertility in men than in women. All it takes is an interview, physical examination and semen analysis.

Semen (male ejaculate) consists of sperm cells and the combined secretion of several accessory glands of the male reproductive system (prostate gland, seminal vesicles, and bulbourethral glands). The sperm cells account for less than 10 percent of the volume of each ejaculate.

The normal male ejaculate has a volume of 2.0-5.0 ml. It can be poured from a pipette (a small glass tube) in droplets rather than a thick strand. It contains 20-250 million sperm cells per ml. At least 60 percent of the sperm cells are motile up to three hours after ejaculation and at least 60 percent of the sperm cells are morphologically normal when seen under the microscope.

If the male semen conforms to all the parameters enumerated above, then the male is fertile. Otherwise, he is infertile and further examination and work-up has to be done to determine what causes his infertility. By the way, for the result of the semen analysis to be valid, the semen must be submitted for examination within two hours after it has been collected. Likewise, it is imperative that there be ejaculatory abstinence period of three to five days before semen is collected for examination. Furthermore, two semen examinations, performed at least two weeks apart, are needed before a diagnosis of infertility can be made.

There are numerous possible causes of male infertility, but many of them are correctible. One easily correctible cause is excess heat at the area of the testes Ė the sperm cells germinate in the testes at a temperature that is slightly lower than core body temperature, which is why testes hang out of the body-hence anything (e.g. clothes, supporter, etc.) that will unduly warm the testes will lead to low sperm count.

Other possible causes of male infertility include cryptorchidism (undescended testes), varicocoeles (enlagred veins) in the scrotum, psychological stress, poor nutrition, infection, concomitant illness such as diabetes mellitus, abnormalities of the testes and the ducts that convey the sperms from the testes to the outside, erectile dysfunction, and hormonal problems.

Over 50 percent of infertile men can be treated successfully. Treatment depends on the cause of infertility and range from surgery or medications to lifestyle changes.

Paul Ellis - Men's Health

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