Healthy sperm may still not mean pregnancy: Nagpur doctor lists two problems in men

Sperm count and quality are considered important when assessing male fertility. But the ability to deliver sperm to the woman's reproductive tract during intercourse can also affect a couple's chances of conceiving naturally.

According to Dr Pramod Yerne, a fertility specialist at Birla Fertility & IVF, Nagpur, sexual function and fertility are both linked to reproductive health but are different things. A man may produce sperm normally and still have difficulty achieving an erection. Similarly, a man with no difficulty in intercourse may have an abnormal semen analysis report. Dr Yerne says it is very important to understand this difference when examining couples trying to conceive.

Erectile dysfunction means a persistent inability to achieve or maintain an erection sufficient for intercourse. When it makes intercourse difficult, the chances of natural conception can fall. Ejaculation disorders, meanwhile, can affect fertility in different ways.

If ejaculation is delayed or does not occur at all, semen may not reach the vagina. Some men have retrograde ejaculation, in which semen travels backwards into the bladder instead of coming out through the penis. As a result, sperm do not reach the woman's reproductive tract and natural conception becomes difficult.

These problems can have several medical and psychological causes. Diabetes, hormonal imbalance, nervous system disorders, problems affecting blood flow and certain medicines can interfere with normal sexual function. For example, uncontrolled diabetes can damage the nerves and blood vessels involved in erection and ejaculation. Stress and performance anxiety, especially when intercourse is timed around ovulation, can add to the problem. Even so, persistent problems should not be dismissed as purely psychological, as a hidden medical condition that needs attention may lie behind them.

Evaluation begins with a detailed medical and sexual history, to understand the nature of the problem and how long it has lasted. Based on this assessment, doctors may advise a semen analysis to check sperm count, motility and shape. Treatment depends on the root cause. It may include medicines, control of associated illnesses, or specific medical measures for ejaculation disorders.

If natural conception does not occur even after these measures, assisted reproductive technology (ART) such as IVF with IUI or ICSI may be considered, depending on sperm quality and other aspects of fertility. In select cases, special sperm retrieval procedures may also be needed to obtain sperm.

Dr Yerne says couples who face persistent difficulty with erection or ejaculation while trying to conceive should seek medical advice without delay. Establishing whether the problem lies in sexual life, in sperm quality or in both can help in choosing the right treatment and improving the chances of conception.