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Male fertility


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Male fertility

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Male fertility

  1. 1. 6 · JUNE 2013 AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET Male infertility does not need to stop you from starting a family KNOW YOUR OPTIONS It’s important to understand that there are many options available to combat fertility problems PHOTO: SHUTTERSTOCK Dr Tim Child,consultant gynecolo- gist and director of the Oxford Fer- tilityUnit,Oxford,explains:“Athird of infertility is primarily male re- lated.Potential risk factors include undescended testicles at birth,dia- betes,obesity,being on certain pre- scription drugs,excessive smoking or alcohol consumption,and expo- sure to chemicals or heat. Erectile dysfunction and previous surgery in the groin can too contribute to malefertilityissues. “A semen analysis is the first test to be performed. It can help detect abnormalities in sperm count or motility.If little or no sperm is pro- duced, a likely cause is testicular failure — when the testicles don’t make enough of the male sex hor- monetestosterone.Ahormoneanal- ysiscanhelpdeterminewhetherthe problem is in the testicles on in the hypothalamus,the part of the brain that signals the testicles to produce testosterone.A blood genetic test is also useful to detect anomalies at the chromosomal level,which may indicate the presence of testicular failure.Further,advanced tests have recentlybecomeavailablethatiden- tify problems in the chromosomes of the sperms themselves.However, thesenewertestshavenotbeenvali- datedyet.” Treating the couple “In most cases,it is not possible to find and treat the cause of the male fertility problem,but we can ‘treat’ thecoupleintermsofhelpingthem conceive,” says Dr Child.“If there is no significant sperm abnormality, we encourage the couple to contin- ue to try for a pregnancy naturally, bymaking changes to their lifestyle and having regular unprotected in- tercourse around the time of ovula- tion.If there are sperm abnormali- ties, the best option is in vitro fer- tilisation (IVF). The procedure in- volves removing one or more eggs fromthewoman’sovaryandmixing them with a sperm sample provid- ed by the man to allow fertilisation in the laboratory.The fertilised eggs arethentransferredtothewoman’s uterus. If the man doesn’t produce sperms we surgically retrieve a small sample from their testicles. Inthiscase,weinjectasinglesperm into each of the retrieved eggs.Cou- pleswhoareunabletousetheman’s sperm can utilize that of a donor.In vitrofertilisationiswidelyusedand canbeveryeffective.” More awareness is needed “Most couples are unaware of the options available to them. That’s whythe new2013 National Institute for Health and Clinical Excellence (NICE) guidelines aim at improv- ing access to the various treatments for fertilityproblems,” says Dr Child, who was the IVF expert in the pan- el that produced the guidelines.“In this regard, a significant effort has gone into trying to increase aware- ness among GPs because,while it is not up to them to arrange the provi- sion of fertility treatments,it is im- portant that they timely refer cou- ples to the right specialist.And time is of essence, because as a woman gets older the rate of success of fer- tilitytreatmentsdiminishes.” LORENA TONARELLI NEWS ■ Question: Why is it so important that men who have a fertility problem seek prompt medical attention? ■ Answer: Because tests can identify the causes of the problem, and treatments can help couples get pregnant. The highs and lows of IVF “InfertilityandIVFaretopics thatmostmendon’ttalk about.Onlymenwhoknow othermenwhohavebeen throughtheprocessmay touchuponthesubject.But outsideofthatyouarepretty muchgoingtobeonyour own,”saysPeterVasey,41. “After avoiding IVF for 8years,try- ing almost every other route to conception open to us,in the end our options were made brutally clear:itwasIVFornothing. “Forme,therewereseveralparts of it which were emotionallyvery tough.Watching the one you love deeply traumatised because she is unable to naturally conceive; watching her endure a barrage of invasive tests,injections and hor- mones and then watching her hopesbuildastheeggsarecollect- ed and fertilised and the resultant embryostransferred. “In IVF thewoman takes all the pain — so it must be a doddle for the man? Well,no,it is tough.Be- cause as a man you can do abso- lutely nothing all about it. Men arefundamentallybystanders.I’m genuinely not looking for sympa- thy towards the male role here, I amjusttellingitlikeitis. “All the weight of IVF falls upon the woman which is incredibly hardtobear.Iamgeneralisinghere butmenoftenaren’tgoodatshow- ing emotions,and for once this is actuallyquite useful.You can’t get stressedandyoucan’tburdenyour emotions on to your wife or part- ner.Themaleroleinthisprocessis togrityourteethandgetonwithit. “Is IVF as bad as I have made it sound? Well,yes and no.The lows are of a level I would have never thought possible, but the highs are the most incredible,emotion- al and deeply joyous highs I could have ever wished to experience. When IVF works, the process be- comesutterlyirrelevant. “These days, I really have to thinkhardtorecallthebadpoints. Andifmywifeaskedtogothrough itallagaintomorrow?Knowingall the pitfalls, risks and emotional strings,wouldI?Absolutely.