An inconceivable idea

At age 17, Chris Dorrington realised that he wasn’t developing as fast as his friends at school. He was very self-conscious about IT and asked his parents to schedule an appointment with their doctor. Chris was shocked when, after his physical examination, the doctor told him that he would never be able to have children. The GP referred Chris to a urologist who explained that he was just a very late developer. Chris can’t recall if the urologist put him on any medication or if tests were performed. As far as he remembers, it was left at that. Although he has always loved children, at 17 his infertility didn’t seem like the end of the world, but still he battled with depression as a result of the diagnosis.

Chris was given anti-depressants for about six months, and shortly after coming off the medication, he went to the UK. There he was diagnosed with Secondary Hypogonadism, which means he has a faulty pituitary gland. This gland is often called the “controller gland” and it’s responsible for controlling many other glands in the body by the hormones it’s supposed to secrete. In Chris’s case, it wasn’t secreting the correct levels of Luteinising Hormone (LH) and Follicle-Stimulating Hormone (FSH) which, amongst other things, control the development and function of the testes. As a result of this, his testes didn’t develop at the normal rate and, in turn, didn’t produce sufficient testosterone.

The doctors never mentioned fertility during any of his check-ups and examinations, so Chris assumed that his original prognosis was correct. His wife, Juanita was aware of his condition before she and Chris got married and they both accepted that they would never have children. They returned to South Africa in late 2007 and, in January 2009, Juanita broke the news that she wanted kids.

Chris agreed to see his GP again, who decided to resume the testosterone treatment (as Chris had been on and off the injections for years), followed by a semen analysis. A few months went by, and the semen analysis came back with a zero count, meaning there was no sperm present.

He then went to a fertility clinic in Cape Town, and once again a zero sperm count came back. They were told that they had two options if they wanted to start a family: donor sperm or a treatment plan to try to get Chris’s body to produce sperm. The second option seemed a long-shot and Chris would need weekly testosterone injections for a year or two before they could hope to see any results – if any at all.

Chris has had four injections every week since November 2009 and numerous semen analyses, which have all come back with a zero sperm count.

Eventually in May this year, Chris and Juanita got a phone call from the embryologist at the clinic. They had found sperm motility in the semen sample he had produced 15 minutes earlier. The treatment protocol was working!

Since then, Chris has remained on the four injections a week, in the hope that the results will keep improving. Chris and Juanita then scheduled an In Vitro Fertilisation (IVF). With so few sperm, IVF with Intra Cytoplasmic Sperm Injection (ICSI) became their only option. At their first IVF in July 2010, they implanted all three embryos, but none resulted in a pregnancy. They then had a second IVF cycle in September, which was cancelled as they had only retrieved two eggs, one was fertilised but didn’t grow.

The most recent sperm analysis (from the cancelled IVF cycle) revealed that there were one million sperm in the sample. Chris is currently continuing with the injections in the hope that the count will improve the quality and quantity of sperm produced and that it might increase sufficiently to make IVF an unnecessary process.

Male infertility is a reality
 

Johannesburg-based Reproductive Medicine Specialist, Dr Merwyn Jacobson from Vitalab says, infertility in men is a genuine medical issue, and accounts for nearly one half of all infertility cases. According to Dr Jacobson, male infertility is the reason that up to 40% of South African couples cannot achieve pregnancy.

“The production of sperm is a very complicated process that begins at puberty and continues in healthy males until late in life,” says Jacobson. He points out that the potential causes of male infertility can be attributed to the following:
• Smoking
• Recreational drugs like marijuana, heroin and cocaine
• Alcohol abuse
• The use of performance-enhancing drugs such as anabolic steroids
• Wearing tight underwear
• Exposure to toxic chemicals
• Hormonal problems
• Physical problems such as damaged sperm ducts, varicocele (varicose veins of the testicles), infections such as mumps or sexually transmitted diseases, retrograde ejaculation (when semen is redirected into the bladder instead of ejaculated through the urethra), and having had a previous vasectomy
• Psychological and physical problems such as ejaculatory dysfunction, premature ejaculation and ejaculatory incompetence (inability to ejaculate or constantly struggling to achieve orgasm even though normal sexual desire and stimulation is present) may also lead to infertility in men

Dr Jacobson explains that the abovementioned lifestyle choices, as well as hormonal, physical, and psychological problems may result in anything from complete absence of sperm, to a low sperm count, abnormal sperm shape, problems with sperm mobility, or sperm that’s completely immobile.

Medical disorders can also reduce male fertility. Dr Jacobson explains that any medical condition that affects the general functioning of the body can play a role in reduced male fertility. “Heart disease and its appropriate treatment; lung disease and the poor oxygen supply associated with it; kidney and liver disease and the fact that many toxins are not removed from the body; diabetes and other conditions which affect the metabolic function, such as thyroid disease, may all have an impact on a man’s fertility.”

Available treatments for sperm disorders
 

Dr Jacobson says that one test to evaluate male fertility is a semen analysis. He explains that this will determine the number, activity and shape of the sperm. “This relatively simple test involves the man providing a semen sample which will be evaluated. It’s the overall evaluation of the ejaculate, not only the quantity of sperm that influences a man’s ability to fertilise an egg.”

Fortunately, in a large number of cases, male infertility can be improved either by treating the problem or using fertility treatments. Dr Jacobson explains that the most straightforward treatment options include a course of antibiotics in cases of infection, medication to improve sperm production, or surgical correction to remove varicocele, to repair a duct obstruction, or to reverse a vasectomy.

There have also been huge improvements in overcoming more complicated male fertility problems. “IUI (intra-uterine insemination) is a relatively simple infertility treatment process in which a small, thin, soft catheter is used to place specially prepared sperm directly into the uterus. This procedure is also referred to as artificial insemination and may be used in cases of low sperm count or quality,” explains Dr Jacobson.

He further explains that IVF treatment may be suggested if IUI is not successful or appropriate, or if female infertility is contributing to the problem. “Today, in even the most difficult of male fertility cases, the direct injection of sperm into the eggs via ICSI can now significantly improve the likelihood of pregnancy.” Dr Jacobson adds that other treatments include electro-ejaculation for patients who have spinal cord injuries, epididymal sperm aspiration for men with absent or blocked ducts, and hormone replacement for individuals with pituitary deficiencies.

“Dealing with male fertility problems depends on the cause and severity of the problem,” says Dr Jacobson. He explains that, in many instances, one may not be able to cure a fertility problem, but you might be able to effect some improvement on the sperm quality and function.

Although many infertility problems such as genetic, congenital and mechanical can’t be prevented, maintaining a healthy lifestyle can help men to preserve and improve their fertility.