Rimma Efimkina - Not pregnant yet? You bet!

Now let us talk about male infertility – a man’s inability to fertilize a woman. In this case Wikipedia suggests one more reason than it does for women. They are: 1) ejaculation disorders, 2) sexual disorders, 3) changes in genital anatomy, 4) endocrine disorders, 5) seminoferous (sperm-producing) epithelium damage, 6) genetic, chromosome damages, 7) inflammation, 8) immunological factor.

Again, I abridged the text a lot, but this time i did it, because I have nothing to write about men – no man ever came to me with an infertility problem. Nevertheless, women are the reason of infertility only in 60 per cent of the cases, it leaves men 40 per cent out of 100. My version is this: firstly, many (Russian) men have no idea that a psychologist could help; secondly, that psychologists could help with infertility; thirdly, that I could help as a psychologist.

Actually, when I was writing this book, one man did find out that it was about infertility. He said that in his family both he and his wife were infertile and they had been trying to conceive for five years, and he would come to my forthcoming seminar. He didn’t, he sent his wife instead.

When speaking about the reasons for male infertility, I would like to share an observation: Wikipedia points out that infertility in women has psychological reasons, it does not point out such a reason for men. Does this mean they don’t have a psychological level? However, Wikipedia profoundly describes various sperm pathologies (if you’ll excuse me, I will skip this, as it is not relevant).

I have noticed that in a childless couple the biggest contribution a man does into dealing with infertility is making a sperm deposit for analysis (semen analysis). The rest is for the woman to deal with, even if she is utterly healthy and it’s her partner who is the reason they are childless. I cannot explain this paradox by biological reasons (woman’s ability for childbearing), but rather social and psychological reasons. Many of my healthy women-clients went through with harmful IVF procedure, because they were scared to discuss other options with their infertile husbands.

Ruediger Dahlke brilliantly voiced one of the reasons for this, by stating that a man’s inability to have children could be tied to the fact that on subconscious level he does not want to undertake any obligations and responsibility for a child 8 8 Ruediger Dahlke, The Healing Power of Illness: Understanding What Symptoms Are Telling You . . I agree with this statement, still, I think there are other reasons, but I haven’t got a chance to exercise my knowledge – as I have mentioned, no man ever addressed me as a psychotherapist with an infertility problem. But women do address me on the subject of MALE infertility.

I will unfold the underlying reasons using examples from my practice below. One of them is lack of a better choice. It is well-known that a person always chooses the best of currently available options. I would like to show other options and may be people would like to change their behaviors and their lives.

Here is a typical dialogue from babyblog.ru Internet forum 9 9 http://www.babyblog.ru/community/post/sterility/410091 :

Olunja:Hi! I’m perfectly healthy, our problem is male factor… I had two inseminations 10 10 Insemination is the deliberate introduction of sperm into a female animal or plant for the purpose of impregnating or fertilizing the female for sexual reproduction. … Didn’t work… I didn’t take ANYTHING prior to the insemination, but 36 hours before hand they gave me a shot of PREGNIL. Ouch! It hurt so much!!!!! Then the inseminations… A week later ONE MORE TRY: a shot of PREGNIL to get things going and no more shots after this. Just UTROGESTAL in the form of suppositories daily for a long-long time. Then I lost all hope… Was depressed… I’m bit better now and here we are – doing IVF… Do you make the shots all by yourself? Does it hurt?

Katisha:My mother-in-law does. Did you think the shot hurt? I don’t feel any pain from the shot itself, but my breasts hurt. I do hope AI [artificial insemination] helps, otherwise I’ll have to have laparo 11 11 Laparoscopy, see above. , and then pills, shots… waiting… I don’t want IVF so much. Cheer up, Olunja, our IVF girls go around so happy. You will be fine and it will work for sure!

Olunja:I wish somebody gave me the shots… I have to do this myself. I make them at 9 p.m…. I live in the countryside… Before the first insemination one woman-doctor prescribed 5 pills of something (I don’t remember what it was) which caused OVERstimulation. We had to wait for the first insemination for two more months. I changed my doctor and I’m happy now. And before the insemination the nurse gave me THAT hurtful shot. My hip burnt…

I didn’t want hysterosalpingography 12 12 Hysterosalpingography (HSG), also known as uterosalpingography, is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. either – but I had to…

And I didn’t want laparo – but I had to…

And in BOTH cases EVERYTHING WAS FINE! No problems!.. But still no kids. So my last hope is IVF.

Katisha:Oh, Olunja, I get you. My tests are fine, except for hormones (hystero, HSG, but no lapro), got my ovul [ovulation] induced, I have O for two months now, but no P. That’s why I had AI, so that the spermies got there for sure. So you are having IFV with ICSI 13 13 Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for obtaining of embryos that may be transferred to a maternal uterus. ?

The women of this society have their own slang: ovul, spermies, laparo, hystero. Some words were reduced to one letter: O (ovulation), P (pregnancy), MM (missed miscarriage) – they have to use them so often, one letter is enough to understand what they mean. It’s all fine, a typical conversation, but one thing caught my attention and bothers me from the very beginning: “I’m perfectly healthy, our problem is male factor”. So, does this mean Olunja deals with all these interventions – both surgical and hormonal (and, as it turns out, futile) – for the sake of her husband? And do all the forum readers perceive this so-to-say “treatment” of a healthy person as a norm?

I am shocked . I re-read the contradictions for medical procedures for infertility mentioned above. They include mental disorders, congenital development issues, tumors, acute inflammatory diseases, malignancies. However, I did not find only one contradiction – the woman being healthy. Is it not contradictory to offer damaging procedures to a healthy woman? Isn’t this the man who should be treated if he has problems preventing him from becoming a farther?