Approximately 15-20 percent of all cohabiting couples are infertile. Of these, in up to 50 percent of cases it is the male factor or the husband who is responsible for the infertility.

This means that nearly 7.5 to 10 percent of all men in the reproductive age group are infertile i.e. incapable of fathering children. This is a stupendous figure but one that very few actually know about!

It is important to note that infertility and impotence are not the same entities. Failure to appreciate the difference between the two is a cause of embarrassment to most men who stay away from Andrology Clinics due to the stigma attached to them.

Impotence means an inability to attain or sustain erections for satisfactory sexual intercourse.

The term has no bearing whatsoever on the fertility status of men. It is thus possible for a totally impotent man to be potentially fertile where it will be possible to produce a pregnancy in the wife of such a man by insemination of the husband's semen.

Infertility, on the other hand, means an inability to produce children. This results from the husband's semen being infertile or sub-fertile. Most infertile men are perfectly normal in terms of potency and have very satisfactory sexual relations with their partners.

Causes of Male Infertility

The first test in the evaluation of the infertile male is the semen analysis. This test is easy to perform and gives valuable information.

In the case of male infertility, the semen analysis is abnormal. Either the count is low (oligospermia) or sperms are altogether absent in the ejaculate (azoospermia).

Sometimes, sperm mobility is seriously affected (asthenospermia) and sometimes the sperms are totally immobile or dead (necrospermia). There are many other anomalies that one may find on semen analysis.

Some of the other tests that may need to be performed are a semen culture, anti-sperm antibody estimation, scrotal ultrasound, hormonal assays, karyotyping.

The following modalities of treatment are generally employed :

Medical treatment

This consists of the administration of certain drugs to improve seminal quality. Clomiphene citrate, mesterolone, tamoxifen, gonadotropin injections, antibiotics, steroids etc. are commonly used.

Surgical treatment

Obstructions in the sperm conduction pathway, varicoceles, undescended testes etc. can be treated by operation. Modern microsurgical techniques are of great help. Even patients who have undergone a vasectomy in the past can have their vasectomy reversed and the tubes recanalised successfully using microsurgery.

Assisted reproduction

In many cases, neither medicines nor operations are of help. In such cases, an attempt is made in the reproductive laboratory to improve semen quality and facilitate the penetration of the sperm into the ovum. This includes sperm washing/capacitation, intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), in vitro fertilisation (IVF), and micro-manipulation (ICSI).

But these are not deterring factors. With medical science advancing by leaps and bounds, the problem of infertility could be treated under expert medical intervention.

Newer avenues of treatment options are being explored and tested, and the time is not too far when this would be an easily manageable and controllable problem.