Help! My husband has no sperms; can he be treated?

Dear Doctor,

My husband and I have suffered infertility for over five years. He has only recently accepted to be tested, only to be informed he has no sperms. Does this mean we shall never conceive?

Answer

Involuntary infertility is a distressing situation. The condition is usually suspected when a couple have tried and failed to conceive for at least a year. It is usually important that both the woman and the man get assessed concurrently. The majority will only be found to have a simple cause for the delay in conception. Others will be diagnosed with complex problems, requiring advanced fertility treatment.

The common unqualified perception that women are mostly responsible for infertility is grossly erroneous. Men are solely responsible for delays with conception in at least a third of cases, and contribute to another half of the remaining cases. A diagnosis of male infertility can only be made when men subject themselves to fertility testing. For most men, all that is usually required is a simple sperm test. A normal result virtually excludes male contribution to infertility in most cases.

The most extreme abnormal sperm test result is the complete absence of sperms in semen, as is the case for this query. The first step is always to get a repeat test, as there can be cases where an initial result was erroneously abnormal. If a second test gives same result, this is taken to be confirmatory of the absence of sperms. The next best course of action is to refer such men to a specialised fertility clinic.

A thorough medical exam of the male reproductive system will usually be done to try and pinpoint any physical causes of the absence of sperms. This will be followed by some tests that may include hormone checks and testicular imaging. Screening for rare genetic causes may also be advised.

Locally, most men with no sperms in semen end up being diagnosed with some sort of obstruction. This means that sperms are actually being formed within the testes, but do not find their way out. This is not too dissimilar to blocked fallopian tubes in women. The most common causes of such obstructions are previous sexual infections. Some men with absent sperms will be diagnosed with rare hormonal, genetic or some specific testicular conditions.

Following a complete evaluation, most men with absent sperms in semen can be able to father their own genetic children. The specific treatment offered will depend on the specific diagnosis. But there is a high likelihood of requiring advanced fertility treatment techniques like in-vitro fertilization (IVF), also commonly referred to as test-tube babies. Such services are available locally, though limited by costs. But in very rare cases, the only way out may be to consider use of donated sperms.

Dr Alfred Murage is a consultant gynecologist and fertility specialist. [email protected]