Some causes of male infertility are sometimes correctable. A varicocele may be surgically repaired to improve fertility. Treatment with antibiotics of a chronic infection can enable a previously infertile man to become fertile. In some situations where substance abuse is a contributing factor, it may be essential for the male to abstain entirely from alcohol and/or other drugs and to join self-help groups in order to do so. Re-evaluation of medications prescribed to treat a chronic illness may produce positive results. A careful study of the man's exposure to occupational hazards such as radiation, lead, or dangerous pesticides may indicate a possible solution through change in employment.

In other cases, administration of various hormones can increase a borderline sperm count or suppress sperm antibodies enough to make conception possible. These hormones include testosterone, thyroid hormone and cortisone. In some situations clomiphene citrate (Clomid) or human menopausal gonadotropins (Pergonal), medications that are used to induce ovulation in infertile women, may also be given to a man whose pituitary deficiency is the cause of his inability to father an offspring. In vitro fertilization, originally used more for female infertility, is being used increasingly for the treatment of male infertility.

What is being described as a revolution in treating infertile men originated in Belgium in 1993, when researchers produced several successful pregnancies by the direct injection of a single sperm cell into a human egg in a Petri dish. The important discovery was that men who had no viable sperm in their semen often had at least a small number in their testes. The problem was that getting the sperm out of the testicles required a very expensive operation and an extended hospital stay.

In 1995, American researchers found a much easier and cheaper way to extract the sperm: by aspirating them through a thin needle in a procedure that can be done in the doctor's office. Even though the needle aspiration is not very expensive, it has to be combined with in vitro fertilization and the direct injection of sperm into eggs. The combined procedures, known as intracytoplasmic single sperm injection (ICSI), can cost as much as $15,000, an amount not likely to be covered by insurance.

The extraordinary advantage of this new development is that it has reduced fertilization to getting the sperm's genes into the egg. It doesn't matter whether the sperm can swim vigorously or even if it can penetrate the egg's outer layer. All that matters is that it is alive. Dr. Richard J. Sherins, director of the male infertility program at the Genetics and IVF Institute in Fairfax, Virginia and the developer of the aspiration technique, believes that it should be of the greatest use to the approximately ten million American men who have had vasectomies. This is encouraging news because while the vas may be surgically repaired, this does not always result in the resumption of fertility. And according to the "New York Times" (6/19/95), even though the method is expensive, it has resulted in a diminishing market for sperm donors both in this country and Europe.

Michael Russell Your Independent guide to Infertility

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