Everything you wanted to know about Infertility
Infertility implies the failure to conceive. It is termed
Primary: when conception has never occured and
Secondary: when the patient fails to conceive after having a child.


How conception occurs.
Conception results from the fertilisation of the ovum (female gamete) by the spermatozoa or sperm (male gamete). After ejaculation the sperms migrate towards the fallopian tubes and fertilisation takes place in the fallopian tubes. The usual life span of a sperm is estimated to be about 24 hours; while the life span of ovum is estimated at 12 hours. So a coitus to be capable of fertilisation, must take place within twelve hours of ovulation (release of ovum from the ovary). That certainly explains why some married couples fail to conceive, though they are potentially fertile. The intercourse should be able to coincide with the short time after ovulation, when the ovum is viable, so that chances of fertilisation are there. And even then there are numerous factors like sperm motility, viability of sperms, etc. before fertilisation can eventually occur.

When does ovulation occur?
It has been concluded after considerable research that ovulation most commonly occurs fourteen days before the onset of the next menstrual period. For example, ovulation will occur on the 14th or 15th day in a 28 days cycle, and on the 10th day in a 24 days cycle.

Is it always the female’s fault if conception is not occuring?
This is a misconception because conception depends upon the fertility of both the partners. Any fault in either partner can lead to inferetility. Studies have shown that 40% of infertility is due to the male partner.


What are the main causes of male infertility?
The commonest reason, is a low sperm count, which can be attributed to various causes;

Idiopathic i.e., when the exact cause is not known.

Varicocele – It is a swollen varicose vein in the scrotum, most commonly on the left side. Blood accumulated in the swollen testicular veins leads to increased temperature in the testis & damages sperm production.
It can be diagnosed, by asking the patient to stand erect and cough . The cord like structure from which the testis hangs i.e., the spermatic cord, feels like a "bunch of worms", on palpation.

Duct blockage – Infection like gonorrohea, TB, filariasis; on surgery for hernia/hydrocele may lead to blockage of the passage between the testes and the penis. In this case sperms will be absent from the semen(azoospermia)

Hormonal imbalance – Hormonal imbalance due to pituitary or adrenal gland can lead to infertility.

Substance Abuse – Exessive intake of alcohol and/or drugs leads to decrease in liver function and increase in levels of the hormone Estrogen which in turn suppresses sperm production.

Testicular factors – like twisting of testis leading to compromised blood supply; undescended testes when the testes lie in the abdomen; and damage due to exercise or heat can decrease sperm production. Testes lie outside the body in the scortum because they can produce sperms in a cooler environment. So clothes like tight jeans, nylon briefs, and hot baths/saunas, lead to damage to sperm production.

Effect of long term medication- certain drugs have an adverse effect on the sperm production. Some of these are Antihypertensives- like reserpine, methyldopa, guanethidine & propranolol
Corticosteroids
Anabolic steroids
Antipsychotics
Certain anti-cancer drugs

People working with harmful chemicals like lead, nickel, mercury, anaesthetic gases, insecticides & pesticides and x-rays, are at increased risk of suffering from decreased sperm count.

Problems with ejaculation- Certain men have problems with ejaculation like problem having an erection (impotence) or inadequate erection for vaginal penetration.

Problems with erection can be due to psychological factors like performance anxiety, inhibitions against sex and due to physical factors like neurologic defects, diabetes, inadequate blood flow to the penis, and also to certain hormonal problems.

Certain tests like monitoring for nocturnal erections and measuring the blood flow through the penis may need to be carried out.

A successful alternative that has come up is collections of sperms by masturbation which later be used for artificial insemination.

Another problem with ejaculation that some men face is that the semen goes backwards into the urinary bladder instead of being ejaculated through the penis. This can occur in men who have had spinal injury or the ones suffering from diabetes, causing improper contraction of urinary bladder sphincter muscle.

Infections – another common reason for male infertility are infections like tuberculosis, chlamydia, gonorrhoea and syphilis. Mumps can lead to complications like testicular inflammation. Infections can damage the male reproductive tract leading to duct obstruction in some cases and decreased sperm production in others.

These have to be treated by antibiotics and semen culture can tell whether infection is controlled or not.

Can something be done to enhance fertility?

Smoking & excessive alcohol intake is associated with low sperm counts. These habits should be discontinued.

Stop using drugs such as body-building steroids & illicit drugs. Other medication such as antihypertensives should also be reviewed in the light of effect on sperm count.

Most importantly the frequency of intercourse should be increased, so that chances of conception increase.

Men should wear loose fitting underwear and cool clothes and avoid high temperature baths like saunas etc.

It is advisable that when the couple is planning pregnancy, intercourse is done in a proper position and using proper technique. Lubricants such petroleum jelly etc. should be avoided.

Are there any investigations, which can help to judge fertility status of a man?

A simple test is Semen Analysis. The pre-requisites are –
Abstinence from sex or masturbation for 4-5 days prior to the day of test.
The sample given should not be more than half hour old
It should be collected in a wide-mouthed, clean jar by masturbation.
The sample is to be kept at room temperature.
Other sophisticated tests like sperm viability test, sperm penetration assay, antisperm antibodies test may be required in certain cases.

Testicular function can be assessed by male hormone levels in blood of the male, or by testicular biopsy.