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.
Infertility has traditionally been thought of as a woman's problem. But as
it turns out, we men don't get off that easily. About one out of every three
cases of infertility is due to the man alone, and we're somehow involved in
infertility about half the time.
A diagnosis of male infertility can be one of the hardest challenges a man
can face. For some, it can be devastating. After all, the necessity of
reproduction is one of the few things on which both Darwin and the Bible agree.
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
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
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."