When the couple sought out medical advice, a doctor showed the husband test results: He was not producing any sperm.
The news sent him zigzagging across the country, searching for the right physician to help him with his infertility. In the meantime, he felt under a great deal of pressure and lost interest in sex.
Finally, the couple ended up at the office of Johns Hopkins University urologist Pravin Rao, who confirmed the problem: a case of mumps the man had contracted as a child in India had damaged his ability to produce sperm. Although he was infertile, a new technique might be able to help.
“For any man, it ultimately takes just one sperm to fertilize an egg,” Rao said. “However, he didn’t even have one sperm. He had azoospermia, meaning there were no sperm in the ejaculate. In this case, this was due to a factory or production problem, as opposed to a blockage.”
Couples are considered infertile if they are unable to conceive after having unprotected sex for one year, or six months if the woman is older than 35. According to the American Society for Reproductive Medicine, about 12 percent of couples in the United States, or 7.3 million couples, fall into this category. In about 40 percent of those cases, the problem is with the man.
Male infertility can be caused by such general health conditions as obesity and cancer as well as by problems including an obstruction in the ejaculatory ducts, a hormonal imbalance and genetic abnormalities. Also, childhood diseases such as the mumps, and sexually transmitted infections such as chlamydia and gonorrhea can cause genital-tract scarring that obstructs the flow of sperm.
There is an ongoing debate over whether sperm counts are going down worldwide. Some studies suggest rates are declining, but others point to inconsistency in data collection and standards.
“Sperm counts do appear to be falling,” said Paul Turek, a San Francisco urologist who writes a popular blog that addresses male infertility. “But we are fully the men our grandfathers were. Women may be getting pregnant as efficiently as they did, but with fewer sperm.”
In the best of scenarios, a man deposits millions of sperm at the base of a woman’s cervix during ejaculation, and the sperm swim their way through her cervix, uterus and fallopian tubes just in time for one of them to fertilize an egg.
The production of sperm and testosterone begins when a boy reaches puberty and continues well into his 80s. Women, on the other hand, release the highest-quality eggs when they are young and stop altogether at menopause.
“Men always are producing sperm unless something happens in life,” said Stuart Moss, program director for male reproductive health at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the National Institutes of Health. “Sperm are constantly being produced, a thousand sperm per second.”