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.
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."
In Tom's case the tests revealed two pieces of bad news.. First, his sperm count was only 10 million, making him statistically infertile. What's more, an analysis of his microscopic swimmers showed a high percentage of malformations. His Neiman-Marcus body, it seemed, was pumping out Kmart-quality sperm.
Eventually, Tom was diagnosed with a common cause of low sperm quality -- varicoceles of the veins of the testicles (similar to varicose veins of the legs). When one or more of the veins becomes inflamed, Lipshultz explains, the valves get worn out, forcing blood to run in the wrong direction -- into the testicles instead of away.
As blood overheats the testicles, the overly warm temperatures damage or destroy sperm cells. Sperm thrive in temperatures several degrees cooler than body temperature, which is why the testicles are housed in the scrotum. It's also why doctors tell men who are trying to conceive to stay out of hot tubs (as well as quit drinking and smoking). "Nicotine, alcohol, and over-heating are toxic to sperm," says Lipshultz.
Luckily, in the case of varicoceles, doctors can tie off the damaged veins. After the procedure, which requires anesthesia but can be done at outpatient clinics, about 70% of patients show improved sperm count and quality. Of these, 40% go on to become fathers.
Happily, Tom was among the lucky 40%. His long and sometimes embarrassing odyssey from gynecologist's office to the operating table was never easy. But he got a wonderful reward for his efforts: a beautiful 6 pound, 2 ounce, baby girl.
Michael Alvear is an Atlanta-based writer. Besides WebMD and other publications, his work has been published in The Los Angeles Times and the Internet magazine Salon.com.