Statistics show that males are responsible in 50 percent of the sub-fertility cases. Male factor is alone responsible for about 30 percent of sub-fertility cases. In 20 percent cases both partners have some problems in reproductive abilities. In infertility cases, not only the female partners, but also the male counterparts must go through the medical examination.

Normal fertility is usually defined as achieving a pregnancy within 2 years by regular coital exposure. But this is not the universal rule as in many cases, some factors or conditions like age of the female partners, family history, medical history or even the occupational history of either partner necessitate early evaluation and treatment of the couple.

While seeking for treatment options, we must remember that both partners should be evaluated at the outset and treated simultaneously. Because it takes months to evaluate a female and spermatogenesis (sperm production in male) takes about 90 days to complete a maturation cycle. So it saves time and duration of treatment if both partners are treated simultaneously.

In order to understand the male subfertility the underlying causes should be reviewed.

One may have problem in the pathway carrying the semen or sperm. After being produced by spermatogenesis in the testes, sperm propels through tube like structure called epididymis and vas deferens to mix with fluids from seminal vesicle, prostate and other glands forming semen that ejaculates through ejaculatory duct outside the penis.

A male may have blocks at any point of this pathway or vas deferens may be absent congenitally. As a result, sperm remain absent in the semen or very scanty in number if the blocks are partial. Moreover, as spermato-genesis goes on, one does not have to worry much about one's fertility ability.

Sometimes semen analysis reveals no sperm or a very little amount of sperm due to failure of spermatogenesis or inadequate production of sperm in the testes. In these circumstances, there are chances to retrieve sperm by fine needle aspiration in 15 to 35 percent cases. Here specialists use micromanipulator for intra-cytoplasmic sperm injection (ICSI) into the ova for fertilisation that leads to development of embryos and ultimately to pregnancy.

Sometimes antibodies are produced against own sperm in many males rendering the sperm unable to fertilise an ova. He should consult with a specialist. There are quite a few options to address this problem.

Seminal vesicle and prostate contribute about 90 percent of the total volume of semen and nearly all constituents except sperm of the semen. It is very important that they function well and there is no acute or chronic infections as well as atrophy or dysgenesis of seminal vesicle.

At birth, testes of a baby may not descend in the scrotum. This is cryptorchidism. If the testes do not descend in place by first one year, they loose the ability of sperm production in adulthood.

There are other causes as well like genetic problem, torsion (twisting of spermatic cord that provides the blood supply to a testicle), orchitis (inflammation of testes) following mumps or due to some other infections. We should vaccinate our children against mumps.

Some drugs are also implicated with the fertility problems of males such as Sulphasalazine, Ketoconazole, Chlorpromazine, Amitriptyline, Imipramine, Thiazides, Spironolactone, Calcium channel blockers etc.

So mention about any long term medication to your doctor when you are seeking treatment for infertility. When a person gets radio- or chemotherapy, he may have to compromise with his reproductive ability.

A few males also suffer from the imbalance of hormones controling spermatogenesis especially Gonadotropin Releasing Hormone, Follicle Stimulating Hormone (FSH), Leutinizing Hormone (LH), Testosterone, Prolactine and Thyroid hormones. These conditions are treatable in most of the cases and the male regains fertility ability.

Steroids also have a bad impact on fertility. Although it enhances our physical performance, it also suppresses hypothalamic-pituitary axis that secretes and regulates hormonal control for spermatogenesis. These anabolic drugs also cause testicular atrophy. So it becomes counter-productive when one takes testosterone capsule or injection for having reduced number of sperm in his semen. Alcohol, marijuana, cocaine etc. also compromise one's reproductive ability by suppression of spermatogenesis.

A meta-analysis shows that there is reduction in sperm concentration ranging from 13 to 24 percent who smoked compared with non-smoker males. Nicotine reduces antioxidants in the seminal fluids; as result sperm membranes get affected. So one should quit smoking to improve one's reproductive ability.

When couples try to conceive, 16 percent will still be unsuccessful at the end of 1 year, 8 percent after 2 years and 7 percent at the end of 3 years. So the wise thing is to keep patience and consult with a specialist.

We should not take in account the myths regarding male subfertility. Men with compromised reproductive abilities are now able to be a proud father - the most cherished divine blessings on earth.

The writer is a Consultant, Infertility & Assisted Reproduction of Labaid Fertility Centre, Labaid Specialised Hospital.