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Most men are very reluctant to get their sperm tested. For one, most men hate going to a doctor - and they need to be dragged to the clinic for any medical testing - whether it's a X-ray or a sperm test. Secondly, most men still believe that having a baby is their wife's job, so it's the wife who should get tested. For another, they expect that their sperm count must be fine , so why bother to get it tested ? " Hey - I can have sex as often as I want, and if my virility is fine, I am sure my fertility will be superb too ! Why waste time and money getting it tested ? " Finally, it can be quite humiliating to have to go to a lab to produce a semen sample - and this is an experience most men are quite happy to bypass.

The problem is much worse for men who know that they have a low sperm count. They are secretly petrified that their sperm count may drop even further , which is why they are so reluctant to get their semen re-tested ! ( They also know that if their sperm count is low, their spouse will nag them incessantly to stop smoking and stop drinking - and is having a baby really worth giving up all the pleasures of life for ? )

This reluctance on the part of the man is not something many wives understand - " I am the one who has to go through all the painful tests and shots , so why is he making such a big deal about getting his semen tested ? " Ironically, the wife is being amazingly unempathetic in this case. While it's true that it's usually men who are clueless, any wife who does not understand the heartburn an infertile man goes through when his sperm count come back as below normal is being remarkably obtuse and clueless. The secret fear many men with a low count have is that the sperm may keep on dropping until it goes to zero - and then what ? Men are masters as denial - and since most of them hate going to a doctor for any medical problem, it's quite understandable that they are not happy about allowing their vulnerability to be exposed to the whole wide world ! And while producing a semen sample is not as painful as doing a HSG, being forced to produce semen on demand in a dark, smelly bathroom when there are five other men waiting in line can be very unpleasant ! Even worse , if the man fails to get an erection and produce a sample when asked to, this can often be the last nail in the coffin of his self-confidence. He'd rather go and shoot himself than put himself through the humiliating ordeal once again.

Sadly, many doctors do not realise the enormous stress some infertile men go through when producing a semen sample - and this just contributes to the difficulty. Since most nurses in an IVF clinic are female, it's very hard for a man to talk about his personal problem to anyone ( the doctor's never available in any case !) And if he fails once, this often becomes a self-fulfilling prophesy, setting up a negative vicious cycle which is very hard to crack. Seeing his wife angry and upset just adds to the man's woes - and he'd rather just forget about having a baby rather than subjecting himself to the stressful exercise all over again !

I just saw a very distressed young man . He had been married for 3 years, but had still not been able to get his wife pregnant. His wife had got all her tests done, and her gynecologist had confirmed she was fine . She then asked him to get his semen analysis done, and this is where he was stuck . The problem was that while his libido was fine, and he had an active sexual life, he had been unable to get his semen analysis done. Every time he went to the lab for a semen analysis, they told him that they were unable to do it, because there was nothing in the container that they could analyse !

His gynecologist dutifully referred him to a surgeon, who examined him and confirmed he was normal. He asked him to go to another lab for his semen analysis - with exactly the same results !

The doctor told him blankly - If you cannot get your semen analysis done, I cannot help you, sorry ! He then changed another two doctors. One suggested he visit a psychiatrist, to help with his "erectile dysfunction"; while another suggested that they could do a testis biopsy to see if sperm were being produced in his testis or not.

He was completely fed up. " Doctor, I know I do not have impotence or erectile dysfunction ! I get a perfectly adequate erection - it's just that I have not been able to get my semen sample tested so far , because when I get an orgasm, nothing comes out of my penis ! I am not an idiot ! Why don't my doctors believe me ? And why can't they help me ? Am I a freak ? "

The problem is that the eye only sees what the mind knows, and many doctors are not comfortable dealing with the infertile man because they do not have much experience in handling these patients. While they learn now how to manage common problems such as erectile dysfunction or azoospermia ,they are surprisingly clueless when dealing with uncommon problems ! And if the patient does not fit into their pre-existing notion of the correct diagnosis, they are quite happy to adopt Procrustean techniques until the square peg fits into the round hole !

The first thing I did was sit down and take a detailed history, probing systematically into the following steps :

sexual desire;
erection;
ejaculation and
orgasam.

He had no problems with libido; his erection was satisfactory; he got an orgasm; but there was no ejaculation even after he got an orgasm. This meant his problem was orgasmic anejaculation , also known as aspermia.

The commonest reason for this is that the man ejaculates his semen backwards into the urinary bladder. This is called retrograde ejaculation. I told his to get his urine tested after his next orgasm - and just as I suspected, there were lots of sperm in his post-orgasm voided urine sample ! When I showed him these under the microscope and told him we could use these for ICSI , I was gratified to see a big smile on his face. " Thanks so much, doc ! It's such a relief to know I am not a crackpot and am not going crazy. None of the other doctors would believe me !"

He was grateful, not just because I had made the right diagnosis and could offer him an effective solution to his problem, but because I had treated him and his complaint with respect. I had used the oldest therapeutic tool of a healer's armamentarium - a patient hearing !

All I had done was listen to him; and translated his complaint into medical terms, which I could then analyse intelligently. The other doctors had just tried to lump with all the other common problems which they see daily - and when he did not fit, they labelled him a crock !

The truth is that not all patients will have garden variety problems - and the most important tool for solving rare problems is a detailed history ! This is very low-tech and inexpensive, and rarely inspires awe, but is the differentiating factor between a good doctor and a run of the mill physician. An expert doctor knows how to take a history; which questions to ask - and which to probe further !

" Listen to your patients. They will tell you what is wrong with them." This is an aphorism which is often attributed to Dr William Osler. This is as true today as it was centuries ago !

The semen analysis report is the basic test of a man's fertility. However, this is a complex report and it can be hard to make sense of the numbers on this laboratory test.

Here's a free simple tool to help you make sense of what your sperm test numbers mean !

View a sample SEMEN ANALYSIS REPORT here !