The poor infertile man

Male infertility is common, and is usually responsible for about 40% of all infertile cases. The commonest reason is the low sperm count, also known as oligospermia.

What breaks my heart is the poor quality of treatment which these men get. Typically, they go to a gynecologist who has no clue about how to deal with men , because all they do is deal with women. However, when confronted with something they don't understand, like most doctors, they mindlessly tick off lots of boxes on a laboratory order form, to "investigate" so they can make a "diagnosis". They usually order a panel of tests , including hormone levels ( such as FSH, LH, prolactin, tesosterone); karyotype                   ( chromosome test ) ;  and a doppler ultrasound ( to check for a varicocele). However, none of which these are any use whatsoever in a man with a low sperm count ! The very fact that the man has some sperm in his semen means all his tests are going to be normal ! Most minor abnormalities are of no clinical importance.
Even worse, these results don't provide any actionable information , because there's nothing we can do to increase the sperm count ! However, doctors are never happy just prescribing tests - they love to " treat" as well ! They advise a lot of lifestyle modification measures, such as eating a healthier diet; doing more exercise; taking cold water showers; wearing boxer shorts; reducing stress levels; taking holidays; as well all kinds of empirical therapy , such as antioxidants . All this expensive rubbish doesn't help with improving the man's fertility at all, but just ends up making him feel persecuted. Yes, a man's sperm count will occasionally increase , but this hardly helps - fluctuations in the sperm count are very common, even without treatment.
However, all this therapeutic meddling makes the poor man's life hell. As it is, he feels inferior and inadequate, because he can't get his wife pregnant - something which any normal man should be able to do with ease ! His low self-esteem just gets worse, and he blames himself for being the cause of his wife having to suffer taunts from the rest of the world.

Even after complying with all the onerous restrictions placed on him ( no social drinks, and not even an occasional smoke), most of the time there is no improvement in the sperm count at all. This is when he loses confidence completely in all doctors.

The man with a low sperm count should just accept the fact that there are lots of things doctors don't understand. One of these is why men have a low sperm count, which is why we can't do much to increase it.
If you are one of those unfortunate men who does happen to have a low sperm count, please stop beating up on yourself. Make sure you repeat the test again, preferably from another more reliable lab , to confirm the diagnosis. However, if the results  remain persistently poor, then your options are limited.

Some gynecologists and IVF centers will refer you to an andrologist , who's supposed to be a specialist in treating male infertility. However , the reality is there's very little this specialist can do for you.  Good andrologists will be honest and tell their patients, "Look, there's no point in wasting your money taking all the empirical therapy we're going to give you. It's far better to just go on and do ICSI".

However , this is not something which most patients want to hear, and they often pressurize the doctor into writing medicines for them. When the doctor can see the patient twist his arm for a prescription, he is happy to write this, so he can move on to the next patient , rather than wasting his time on these hopeless cases , for which he knows he really can't do anything. However, this means that another three months of the poor patient's life is wasted, and his poor wife keeps on getting older !

Sadly, the torture doesn't stop even after starting the right treatment, which is IVF/ICSI . If the embryo is of poor quality and the IVF/ICSI  cycle fails, many doctors blame the failure on the poor quality of the sperm, and suggest to the man that they use donor sperm the next time ! This is plainly ridiculous, since the only reason for doing the ICSI in the first place was the poor sperm . When doing ICSI, we need only 1 sperm to fertilise 1 egg , and it doesn't matter how poor quality the semen sample is at all !

The reason for poor quality fragmented embryos is much more likely to be a poor quality lab, but the doctor blames the man for this, and does even more pointless tests, such as sperm DNA fragmentation, to prove to him that the "fault" is his, and that it his poor sperm which are responsible for the IVF failure !