When you"re planning to become a dad, finding out you"re infertile is a big shock. But male infertility is much more common than you may think.
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After Wayne Allen and his partner Mandy Warrick had been trying to have a baby for something like five years, they decided the time had come to visit a doctor to discuss infertility.
They made an appointment with their local GP. When they went in to talk it over, the doctor"s first suggestion was that Wayne get his sperm count checked, and within days he was delivering bad news.
"He told me my sperm count was zero," remembers Wayne, a senior manager with an automotive company. "That sends shockwaves through your mind. One of the fears is that you"re never going to have your own children."
For the next few weeks, Wayne and Mandy, both in their early 30s, struggled to come to terms with the possible ramifications of the news as they waited to see a specialist. "I really wanted to have kids of my own, but a day or two after the news, we started talking about adoption or using donated sperm," he remembers.
When the appointment time arrived, the specialist investigated Wayne"s problem and came to the conclusion that although Wayne"s testicles were producing sperm, they were being stopped by a blockage in the tubes that run from the testes to the penis.
"That was a fair relief to me," Wayne says. "It meant that they just had to take the sperm out and there was a chance for us to have kids."
The news meant that Wayne and Mandy could try for children via in vitro fertilisation, but it wasn"t a smooth road. Over the next three years, Mandy went through eight rounds of embryo implantation. Finally, in late 2006, they were successful and now have the baby they"d wanted for so long.
"I want a recount"
Wayne"s initial reaction to the news that his sperm count was zero isn"t unusual, says Associate Professor Roger Cook, a psychologist from Swinburne University. He has counselled a lot of men facing infertility and says their responses tend to fall into two main categories.
The first type of reaction is utter surprise and disbelief, he says. Those men simply can"t believe this could be happening to them and often want to have the tests done over again. "I remember one young man who had a kind of Brownlow Medal response," he says. "He said "Oh jeez, I just want a recount"."
There"s another group of men who take the news on the chin. "It"s almost as if they skip the phase of being shocked or upset about it and go into Mr Fix-it mode," Cook says.
There are a small number of men, maybe one in 10, who already had a suspicion that something was wrong, Cook says. But those men, who might have had an accident at some point in childhood, or a severe case of the mumps, are very much the exception to the rule.
"Most men need to be helped to understand how often this occurs in the community," Cook says. "They think it"s unusual because no-one"s ever told them about it."
Don"t go there friend ...
Cook"s experience tells him that men are much more careful about who they talk to about their infertility than are women in the same situation. "As men, we want to be seen as competent, as real men," he says. "We"re quite happy to talk about our appendix coming out, but when it"s inside our pants it"s different. It exposes men as being somewhat vulnerable."
That"s a phenomenon Wayne Allen has seen first hand. Since he and Mandy went through their own ordeal, he"s seen how unwilling some men are to confront the issue of infertility.
"If there was a couple having issues, it would be the female partner who would come to me and ask me to talk to their husbands about it," he says. "I can remember one of my mates in that situation and there was no way in hell he was going to go in and have a sperm count. He was quite a tough sort of a guy and he wouldn"t want anyone thinking he was not manly enough."
The result of this unwarranted shame and embarrassment is that male infertility doesn"t get talked about in the same way that female infertility does. When the Fertility Society of Australia (FSA) surveyed 2400 people last year, only two per cent of respondents thought male infertility was a reason couples sought medical help.
In reality, the picture is very different, says a FSA fertility specialist and gynaecologist, Dr Anne Clark.
According to Monash IVF clinic, about one in 20 men is sub-fertile and male infertility may be significant in half of all infertile couples. About one third of all IVF procedures are performed for male infertility.
And just like women, men experience greater fertility problems as they age, Dr Clark says. "For men, the big drop is about 40," she says. This means that delaying parenthood has a double impact on fertility in a couple.
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Male infertility: what is it?
Formally, a couple is deemed infertile if they aren"t able to achieve a pregnancy after one year of regular unprotected sex. Male infertility is diagnosed when tests have been done on both partners and reproductive problems are identified in the male partner.
Those tests might include a physical examination and analysis of the man"s sperm, looking at their number, movement and shape. Doctors might also carry out blood tests to look at hormone levels, and do geyellowcomic.comic investigations or testicular biopsies.
For roughly two-thirds of infertile men, those tests will reveal an underlying problem with the number, quality or movement of sperm, says Professor Rob McLaughlin from Monash IVF. "Their army of sperm, if you like, lacks numbers, speed and the ability to engage," he says.
The original cause of those sperm problems can be things such as undescended testes, infections from diseases like mumps, injuries to the testes or damage caused by drugs or radiation. However, no cause is found for low sperm counts in around 60 per cent of infertile men.
The second most common cause of male infertility is a blockage of the tubes that take the sperm from the testes to the penis, Professor McLaughlin says. This affects more than one in 10 infertile men.
There are other problems that can cause infertility, too. Those include sexual dysfunction of one kind or another, which can result from spinal injuries, neurological problems or other causes. Antibodies against sperm also develop in some men, which can hinder sperm movement and block egg implantation during fertilisation. About one in every 16 infertile men has sperm antibodies.
Another cause of infertility is testicular cancer, as architect Andrew Cronin can attest. He discovered a lump in one of his testes at the age of 40, just four months after he married his wife Andrea.
"I had surgery and went on my honeymoon," he remembers. By the time they got back from the holiday, another lump had developed in his groin. "The oncologist said, well you can forget about children," Andrew remembers. "But fortunately I"d been to the Women"s Hospital a few weeks before and had some sperm frozen." Using that sperm he and Andrea were able to have a baby, three years later after nine rounds of IVF. Andrea has recently written a book describing their experiences, called Miss Conceived.
What can you do?
There are some causes of infertility that you can do something about, and others that are untreatable.
Doctors say that roughly one in eight infertile men have a condition that can be overcome. Those include some hormone problems; blockages of sperm transport such as vasectomy; sperm antibodies and drug related problems such as the use of anabolic steroids.
A very small proportion of men, fewer than one in 10, produce no sperm at all, a condition called azoospermia, which can be caused by chromosomal or geyellowcomic.comic disorders or other factors. For them, the options include adoption or using donated sperm.
The majority of infertile men fall between these two extremes. They have low sperm counts that doctors can"t do anything about. For men in that situation, a natural pregnancy is certainly not out of the question, but many will benefit from assisted reproduction or in vitro fertilisation.
Explore your treatment options
There are specific techniques IVF specialists can use to combat male fertility issues, Professor McLaughlin says. The best approach depends on the type of infertility and its severity.
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"For men with mild to moderate problems we can use standard IVF," he says. For more severe problems, doctors can use intracytoplasmic sperm injection, or ICSI, where individual sperm are removed from the epididymis or testis and implanted directly into individual eggs.
"ICSI is spectacularly successful and has changed the whole face of fertility practice," says Professor McLaughlin. Find out about ICSI and other treatment options in our infertility fact file.
Open up to others
Whatever happens, though, it"s important to find someone you feel comfortable talking to, Associate Professor Cook says. "You need to think seriously about the relationships you have with family and friends and consider discussing it with them."
Most importantly, opening up to your partner can help allay fears, he adds.
"One of the thoughts men have is that they"ll abandon the relationship and give their wives a chance to find another partner she can have children with," he says.
"But when you talk to the partners, they say that"s not what they married them for and that they"re not going to run off with someone else."