Male Infertility
Infertility may be defined as a failure to conceive in a couple practising regular unprotected intercourse over a period of 12 -18 months. In 30% of cases it is due to the male. Rarely it is due to chromosomal abnormalities such as Kleinfelter’s syndrome, where there is an extra X chromosome (so the chromosome count is 44 XXY, rather than 44 XY). There is failure of sperm production in a tall thin man with increased breast tissue (called gynaecomastia) and small testicles. The syndrome can be tested by examination of chromosomes seen in cells taken from scraping inside the cheek. In most cases, however, the causes of low or abnormal sperm counts can usually not be established. A normal sperm count, obtained by analysis of a specimen produced by masturbation after a three-day abstinence from ejaculation, consists of two to eight millilitres of fluid containing between 20 and 200 million sperms per millilitre, of which 40 per cent should be mobile, and 60 per cent of normal form. Most men considered to be infertile are actually sub fertile - with a reduced sperm count (called oligospermia), rather than completely infertile, with a total absence of sperm (called azoospermia). Subfertility may be due to chronic infection in the epididymis, the prostate or urethra, due to agents such as chlamydia, and it may respond to antibiotics. There is some evidence that a low sperm count can be increased by ensuring that the testicles do not become overheated (wear loose-fitting under pants, don't ride a bike, take cold baths), by avoiding agents which may depress the sperm count such as some anti-inflammatory drugs and alcohol, taking an adequate diet with sufficient vitamins and minerals.
Total absence of sperm from the semen (which is rare) may be due to amongst other things mumps infection, failure of the seminiferous tubules to manufacture sperm, or a blockage in the epididymis which may respond to surgery. A biopsy of the testicle would differentiate between the two.
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