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Most infertile men have poor sexual self-esteem. As it is , they feel inadequate because they cannot get their wife pregnant. On top of this, if they cannot perform in the bedroom, this makes a bad situation even worse.

Sexual problems are as common in infertile men as they are in fertile men. Premature ejaculation is the commonest male sexual problem. It is very distressing , because it makes the man feel inadequate and inferior.

Remember that there is an evolutionary advantage to being a premature ejaculator and this seems to be hard-wired in our genes ! in the past ,wen who could have sex quickly could get lots of women pregnant quickly, and spread their genes far and wide !

This is primarily a psychological problem ; and in many men is the result of behaviour which is learned as a teenager. When you are masturbating in the privacy of the bathroom , you don’t want to be caught by your parents, so you try to ejaculate as quickly as possible. Unfortunately, this behavior is hard to unlearn when you grow up !

Also, many men get misled by assuming that what they watch in blue films is the norm ( while actually it’s just trick photography !)

There are many simple solutions which can help. For one, try having sex a second time after your ejaculate. The second ejaculation is usually delayed and the erection will last longer

You can also change your sexual technique and masturbate your wife first, so she gets sexual release. This will take the pressure to perform off you !

You can also use a local anesthetic jelly locally ( such as Xylocaine) to prolong the time to ejaculation. This is effective, but takes the fun away !

You can also learn techniques such as the Stop-Start or Squeeze technique to delay ejaculation

Some men find that taking the SSRi group of antidepressants also helps

There are also lots of quacks who sell lots of remedies ( online and in real life as well) to “treat” premature ejaculation. They take advantage of a man’s ignorance and inferiority complex – please beware !

Vaginismus is a surprisingly common sexual disorder which causes a lot of distress and low self esteem. Women with vaginismus feel inadequate and incompetent; and they cannot share their diagnosis or problem with anyone. They feel like freaks - and feel guilty that they cannot give their husband sexual pleasure.

Not only does this put a lot of stress on the marriage, the desire to have a baby can often be the last straw which breaks the camel's back ! While the urge to complete the family maybe very strong, they are petrified about the fact that they may need to seek medical attention to achieve this goal. For a woman with vaginismus, even the idea of going to a doctor can cause sleepless nights.

The fact that many gynecologists are clueless about this condition can just end up making a bad situation even worse. They will often pooh-pooh the woman's concerns; or force her to subject herself to a painful , humiliating and degrading exam which makes her feel that she was raped and puts her off going to all doctors for ever ! Many unsympathetic doctors will actually blame the woman for her problem - or advise surgery ( an obsolete operation called a Fenton's) to fix a problem which was never mechanical in the first place !

It needs lots of courage for these women to go to a doctor - and while they can be challenging to manage and need a lot of time, energy and empathy, I take my hats off to these brave women who are willing to put themselves through so much in order to have a baby !

Infertile couples are often willing to move heaven and earth in order to have a baby. However, I find to my dismay that a lot of them do things which actually end up reducing their fertility !

1. They use lubricants while having sex which kill the sperm . Having "baby making sex" on demand is not much fun for either husband or wife - and it's quite common to have to use lubricants in order to be able to achieve intravaginal penetration. However, many couples will use lubricants such as K-Y jelly or saliva - both of which can kill the sperm ! If you do need to use a lubricant, please use a sperm friendly lubricant. The easiest one to buy ( and the cheapest one) is liquid paraffin. It' easy available OTC at a chemist - just look under the laxatives !

2. Timing sex. Most couples know that the wife is fertile for only a few days during the entire month. However, because they are quite clueless about what these fertile days actually are ( and do not whom to ask or how to calculate them), they often end up having sex on Day 14 ( which they remember vaguely from their high school biology class on human reproduction ( when they weren't busy pretending to be blase because they " knew it all" ; or were giggling and blushing) is the day when ovulation occurs and the egg is released). However, for many women, Day 14 can actually be an "infertile day " ( for example, for women whose cycles are 25 days or less) . Using the Free Fertility Calculator at www.myfertiletime.in will help you track your fertility ! Using OPKs can also help !

3. Not having enough sex. Many wives refuse to allow their husbands to have sex until their "peak fertility day". They believe that if they "store up the sperm" and then discharge this with a big bang, their chances of getting pregnant increase. Actually, this is not true. You cannot really store up the sperm - the count does go up when ejaculation is delayed - but it's the immotile sperm which increase - not the motile ones ! It's far more efficient t have frequent sex, as long as the sperm are going in the vagina !

4. Many infertile women still use BBT charting to try to track their fertile day. This is a big, big mistake. While BBT charting does provide useful evidence to the doctor , it's only retrospective evidence - it does not help to identify the fertile days, as the BBT raises only after ovulation has occurred ( at which time the cervical mucus dries up and sperm can no longer enter the uterus and swim up to the egg).

5. Not doing any homework. It still astonishes me as to how poorly informed many infertile couples are about the basics of baby making ! They will often waste time trying herbs and supplements advertised on dodgy websites to "boost their sperm count"; or take "fertility tablets" to increase their fertility. They will allow months to run into years before seeking medical attention - or even doing a basic ( and inexpensive) fertility workup, to confirm that everything this fine.

Many gynecologists advise ovulation tracking as the first line of "treatment" for infertile couples.
This seems to be sensible advise. You just have to go for vaginal ultrasound scans which help you time precisely when you ovulate. You have sex at this time, and since eggs plus sperm = baby, you get pregnant in the first cycle itself ! How can this fail - especially if you are young and all your test results are normal ?

Actually, the tragedy is that patients have very unrealistic expectations from follicle tracking ! The success rate , even in a perfect cycle , is only about 10 % ! Remember that human reproduction is not very efficient, and just timing sex does not help ( unless you've never had sex at the right time earlier !)

Doctors often forget the downside of ordering follicular studies. It can be very stressful because you need to take time out of your office work duties to get ultrasound scans done . Even worse, it can play havoc with your sexual life. We all know that Men are from Mars and Women are from Venus - and this difference gets hugely exaggreated when you are battling with infertility, because you and your partner seem to be on completely different planets as regards having a baby . Most men would rather let nature take its own course - and having sex frequently in order to have a baby sounds like fun ! They just cannot understand why baby lust seems to have taken over their wife's life - and why you are obsessed with stuff like eggs and ovulation and fertile times !

Doctors can be very casual about advising scans and they underestimate the additional stress this puts on the marriage ! Husbands hate having to have sex on demand - they feel they have become reduced to becoming sperm donors who have to perform when ordered to do so. This takes all the fun out of sex, and adds to the marital disharmony when the wife refuses to have sex on any day other than the day of ovulation because she wants her husband to "store up" the good sperm ! This can often be the last straw which breaks the camel's back , because infertility already stresses the couple. Also, having to lie with your legs up in the air for the scans can be quite embarrassing and humiliating - and having a doctor insert an ultrasound probe into your vagina on a daily basis can be a major turnoff !

My advise is that one cycle of ovulation tracking is enough. This can be useful because it teaches you to correlate the scan findings with your body's signals , such as your cervical mucus and ovulation pain . Scanning also allows you to make better use of OPKs and the free online fertility calculator in future cycles, because you understand what's happening to your body, so you do not have to medicalise baby making sex in future cycles and track ovulation discreetly at home !

However, if your doctor advises repeated follicular studies, please get a second opinion ! Otherwise you ( and your husband) are likely to get fed up and frustrated before getting pregnant !

Often an absolutely fertile male with a completely normal sperm count might not be able to ejaculate in his wife's vagina. Because he cannot make love he cannot make babies. Many males cannot produce an erection (erectile dysfunction, ED or impotence); while others can't attain an erection which is hard enough to achieve intravaginal penetration or ejaculation within the vagina.