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    Infertility: It's Not My Fault

    Why do men have such a hard time accepting a low sperm count?

    WebMD Feature

    April 3, 2000 (Atlanta) -- A friend of mine, whom I'll call "Tom," found himself in his wife's gynecologist's office, masturbating into a cup. Tom didn't know whether to laugh or cry. Infertility is no laughing matter, but as he found out, a sense of humor helps.

    Surprisingly, most male infertility testing is done at gynecological offices. Men are just as likely to be infertile as women (40% of cases are attributed to men, 40% to women, and 20% to both). But women typically seek treatment first. When the cause of the problem doesn't lie with them, they often have to drag their husbands to the gynecologist.

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    A million men will visit fertility specialists this year, experts say. And like Tom, many will have a tough time imagining that they could be the cause of their wife's inability to conceive. "Men come in embarrassed, scared, and incredulous," says Larry Lipshultz, M.D., the clinical director of the Laboratory for Male Reproductive Research and Testing in Houston, Texas. "Incredulous that they have a problem, given that they feel so healthy."

    Eldon Schriock, M.D., of the Pacific Fertility Center in San Francisco, agrees. "Denial is common. Men tend to think they've done something harmful to themselves, like playing too much football. It's hard for them to accept that the problem is internal and out of their control."

    Even in the best of circumstances, the odds of conceiving a child aren't great. The typical ejaculation contains 100-300 million sperm, of which only about 15% (15-45 million) are healthy enough to fertilize an egg. Of these, only some 40 sperm survive ejaculation and the toxicity of the vaginal environment to reach the egg and become serious contenders for conception. That's not many, even with a sperm count of 300 million. But when sperm counts fall below normal, the chances of conception plummet. More than 90% of male infertility, in fact, is caused by low sperm counts, poor sperm quality, or both.

    Any man with a count below 20-40 million is considered infertile. But even if a man has a normal number of sperm, at least 60% must be normal in structure, having an oval head and a long tail, to promote conception. Heads that are rounded, pinpointed, or crooked are signs of impaired sperm formation that can make it difficult for the cells to reach the egg. "It's important that sperm move quickly and straight forward," says Schriock, "because they have to swim through layers of cells around the egg before they can penetrate the egg itself."

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