Effect of long term medication-

Certain drugs have an adverse effect on the sperm production. Some of these are Antihypertensive-
like reserpine, methyldopa, guanethidine & propranolol Corticosteroids
Anabolic steroids
Antipsychotic
Certain anti-cancer drugs

People working with harmful chemicals like lead, nickel, mercury, anesthetic gases, insecticides & pesticides and x-rays, are at increased risk of suffering from decreased sperm count.

Problems with ejaculation- Certain men have problems with ejaculation like problem having an erection (impotence) or inadequate erection for vaginal penetration.

Problems with erection can be due to psychological factors like performance anxiety, inhibitions against sex and due to physical factors like neurological defects, diabetes, inadequate blood flow to the penis, and also to certain hormonal problems.

Certain tests like monitoring for nocturnal erections and measuring the blood flow through the penis may need to be carried out.

A successful alternative that has come up is collections of sperms by masturbation which later be used for artificial insemination.

Another problem with ejaculation that some men face is that the semen goes backwards into the urinary bladder instead of being ejaculated through the penis. This can occur in men who have had spinal injury or the ones suffering from diabetes, causing improper contraction of urinary bladder sphincter muscle.

Infections – another common reason for male infertility are infections like tuberculosis, chlamydia, gonorrhoea and syphilis. Mumps can lead to complications like testicular inflammation. Infections can damage the male reproductive tract leading to duct obstruction in some cases and decreased sperm production in others.

These have to be treated by antibiotics and semen culture can tell whether infection is controlled or not.

Can something be done to enhance fertility?

a. Smoking & excessive alcohol intake is associated with low sperm counts. These habits should be discontinued.

b. Stop using drugs such as body-building steroids & illicit drugs. Other medication such as antihypertensive should also be reviewed in the light of effect on sperm count.

c. Most importantly the frequency of intercourse should be increased, so that chances of conception increase.

d. Men should wear loose fitting underwear and cool clothes and avoid high temperature baths like saunas etc.

e. It is advisable that when the couple is planning pregnancy, intercourse is done in a proper position and using proper technique. Lubricants such petroleum jelly etc. should be avoided.

Are there any investigations, which can help to judge fertility status of a man?

A simple test is Semen Analysis. The pre-requisites are –

Abstinence from sex or masturbation for 4-5 days prior to the day of test.

The sample given should not be more than half hour old .

It should be collected in a wide-mouthed, clean jar by masturbation. The sample is to be kept at room temperature.

Other sophisticated tests like sperm viability test, sperm penetration assay, antis perm antibodies test may be required in certain cases.