Women have been blamed for barren marriages from the Bible on. In truth, a fifth of all infertility stems exclusively from male factors, and an additional third involves both partners. Gynecological problems account for only 40 percent of infertility, yet doctors still tend to view it as a female condition. The good news, as Patrick Jermyn discovered, is that the most common male problems can be fixed.
The top enemies can be described in two words: heat and blockage. In order to produce healthy sperm, the testicles need to be four degrees cooler than the rest of the body. That’s why they’re mounted outside the torso. Sperm cells spend three months growing within the testicles, then travel through an ultrathin coiled tube (the epididymis), where they learn how to swim. Finally they move into the vas deferens–two tubes, one from each testicle–which contract to make ejaculation possible.
The most common cause of male infertility is a varicocele, a cluster of enlarged veins in the scrotum. These varicose veins may cause no symptoms (some men experience a slight ache when lifting heavy objects), but the heat they generate may wreak havoc on sperm production. Men with varicoceles can be fertile, but the condition is associated with low sperm counts, sperm that swim poorly and sperm so misshapen they can’t enter an egg. Jermyn’s local urologist checked him for varicoceles but didn’t see any–probably because the patient was sitting on a cold examining table and experiencing the “Seinfeld” shrinkage effect. Later, at Jennifer’s insistence, Patrick visited New York’s Weill Cornell Medical Center. This time he got to sit on a heating pad during the exam–and the urologist, Dr. Marc Goldstein, noticed the telltale tiny, thick spot on his scrotum. Goldstein was able to repair it with a minimally invasive surgical procedure. The operation improves sperm counts, and studies suggest that it more than doubles a couple’s odds of achieving pregnancy within a year–from 17 percent to 43 percent. Three months after the procedure, Patrick’s sperm looked normal.
Besides checking for varicoceles, a good urologist also looks for swelling in the epididymis and vas deferens. Common venereal infections, such as chlamydia and gonorrhea, can leave behind scar tissue that blocks the epididymis. And urologists often discover that a man’s vas deferens has been injured in a past hernia operation–with the same results as an intentional vasectomy. Roughly a fifth of all male infertility involves these mechanical blockages. Fortunately, most of them can be corrected with microsurgery, restoring typical sperm counts in men who would otherwise produce none.
For a normal, healthy male, staying fertile doesn’t require surgery, but it does take some care. Any form of substance abuse, from smoking cigarettes to snorting cocaine, can hamper sperm production. If you’re concerned about fertility, stick to two drinks twice a week. Even a single drinking binge can temporarily disrupt the process, resulting in sperm with deformed heads and curled tails. You should also ask your doctors if any of your prescriptions can hamper fertility. The danger zone surprisingly includes popular items like the ulcer drug Tagamet (cimetidine), the heart drug Crystodigin (digitalis), the alpha blockers and calcium blockers used to treat high blood pressure and standard antibiotics. Sperm quality usually rebounds once the drug is discontinued.
If you’re getting clean, lose the Mick Jagger underwear, too. Anything that heats the testicles–steam rooms, a fever, long drives–can reduce your odds of fatherhood. (Three thousand years ago, Japanese men took daily hot baths as a form of contraception.) Finally, look into occupational hazards. “I’ve seen truckdrivers impregnate their wives after they switched to dispatching,’’ says Goldstein. “And I had a pizza-parlor owner whose wife got pregnant when he stayed away from the oven.”
Finally, couples who discover that the man has a fertility problem shouldn’t assume they will never be parents. A year to the day after Patrick Jermyn left the hospital without his varicocele, Jennifer left another hospital with their son, Ryan Patrick. Last month Ryan had his first birthday.
