Babies Tale

Men’s fertility also falls with age, but more slowly and later than it does in women. Since most older mothers have partners the same age or older, male infertility can exert its own effect. A combination of slightly lowered fertility in both partners can combine to make pregnancy less likely.

Male infertility can be caused by blocked tubes. These tubes, called the vasa deferentia, carry sperm from the testes, where they are made, to the penis. Tubes can be blocked from birth because of a congenital defect, through scarring caused by sexually transmitted diseases, and through surgery, as in a vasectomy. An increasing number of men choose vasectomy once their families are complete, but if the marriage breaks up and they remarry, vasectomy can be the cause of infertility in the second marriage.

Male infertility can also be caused by:

• Undescended testicles. If these are not diagnosed early in a boy’s life, permanent infertility will result.
• Infections involving the testicles. Orchitis, inflammation of the testicles following mumps, can result in infertility rarely.
• Varicocele. A “varicose vein” of the testicle; it may be a cause of male infertility.
• Disorders of ejaculation. Sometimes, as a result of illness, such as diabetes, or surgery, such as a prostatectomy, sperm is ejaculated backwards into the bladder at orgasm.
• Low sperm count, or a large proportion of the man’s sperm being abnormal. Although research is being done, no one really understands what causes low sperm counts. However, their origin is believed to be hormonal.

Treatments

Because so little is understood about the causes of much male infertility, only limited help is available for the majority of men with a low or absent sperm count. Some causes are known (see above) but there is little that can be done about them.

One form of male infertility can be caused by a varicocele, or varicose vein, around the testicle. This can be treated, although its link with infertility has been questioned. A simple operation to tie off the vein may improve sperm quantity and quality in about two-thirds of cases, thus increasing the chances of conception.

Blocked or scarred vasa deferentia, especially after vasectomy, may be restored surgically but there is only a 50% success rate. A man with blocked tubes often produces antibodies to the sperm because they cannot be ejaculated and have to be reabsorbed by the body. A procedure called percutaneous epididymal sperm aspiration can now remove sperm from the testes, and they are used to fertilize an egg.

Other causes of a low sperm count are resistant to treatment.

Various hormone treatments have been tried, with a low success rate. Some studies have shown the success rate is actually lower among treated men than among those who have not received any partner to conceive and bear a child. In 0I, semen is donated by an anonymous donor. The semen has been screened to verify it does not contain any infectious diseases. Then it is introduced through a tube into the woman’s vagina, close to the cervix, by a doctor or nurse. Donors are screened carefully. There is usually an attempt to match the donor’s physical characteristics with that of the woman’s partner.

The woman goes to the clinic once a month at the most fertile time in her cycle (this is usually worked out with temperature charts). If

her periods are irregular, she may be given ovulation-inducing drugs so the doctors will be able to predict the best time for insemination. The woman is usually advised to lie on her back for about half an hour to enable the sperm to swim into the uterus. Rates of conception with 0I seem to be about the same as with ordinary sexual intercourse.

Going through the tests and treatments already described is in itself a remarkable testament to most couple’s desire for a child. By the time these couples consider the new assisted-reproduction techniques, they have probably been through months or years of tests and the more orthodox fertility treatments. At the same time, it can be difficult to decide when to stop. “You feel you’ve already invested so many years and so much pain in all this, you just have to follow through to the end,” said one woman undergoing fertility treatment.

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