The vast majority
of infertile men have no difficulty masturbating to
produce a semen sample – and for some, it may
even be fun ! After all, giving a semen sample is a
lot easier than giving a blood sample – and compared
to what women have to go through, men really have it
easy !
However, some men find it very hard to produce a sperm
sample during infertility treatment. This difficulty
may seem funny, but it can cause considerable heartburn
and distress – and some patients have been forced
to abandon an IVF cycle because the husband could not
produce a semen sample at the time of egg collection
There are many reasons this can happen. Many men need
their wife to help them to produce a sample; while others
are simply not used to masturbating . The commonest
cause is the anxiety and stress associated with producing
a semen sample “on demand” in the clinic
– especially when you know there is so much riding
on it. Many men fail to get an erection because of the
situational anxiety – which is often multiplied
hundred-fold when they are asked to produce a semen
sample in a dirty smelly bathroom, with half a dozen
other men waiting outside for their turn !
If they fail to produce the sample within 15 minutes,
this often sets up a vicious cycle of failure. “Oh,
my God – I cannot get it up ! What do I do now
? Suppose I cannot produce the sample – then what
? “ Often unfriendly clinic staff or unthinking
doctors and nurses may make the bad situation even worse.
Instead of sympathising and helping, they may add to
the pressure by insisting that the man produce within
an hour, or they’ll be forced to cancel the cycle
– or use donor sperm !
How can you prevent such a problem ? Firstly, if you
are worried about your ability to produce a sample on
demand, please discuss this openly with your doctor
well before you start your cycle ! The good news is
that there are many options today which can help the
doctor to help you !
First, however, you need to learn to help yourself.
Practise makes perfect applies in this situation as
well, so practise masturbating, to reduce your stress
levels and enhance your ability to perform when needed
– this will help to boost your confidence in your
abilities.
It’s helpful to come prepared – so carry
a magazine to help titillate yourself ! If you are techno-savvy,
you could even bring your laptop with your favourite
XXX DVD or CD to watch, so you can arouse yourself.
Many clinics now have well-equipped masturbatoriums,
to help you get an erection, but you can also request
permission to carry the semen container home, so you
can bring the sample with you into the clinic. If you
find you cannot masturbate, you can ask your doctor
to give you a special non-toxic silastic condom which
you can wear while having sex with your wife, so you
can collect the sample in this during intercourse.
The best way to manage this problem is by preventing
it. If you have difficult ejaculating on demand, it’s
a good idea to request the IVF clinic to freeze and
store ( cryopreserve) your sperm sample before starting
the IVF cycle. Because you can provide the semen sample
at your convenience, the psychological pressure is removed,
and this frozen sperm sample can be used to treat your
IVF, even if you cannot provide a fresh sperm sample
at the time of egg collection. Interestingly, just the
fact that a frozen sperm samples is readily available
if needed, removes the pressure to perform considerably,
and many men can provide a new fresh sample at the time
of egg collection !
Very rarely, if you find you just cannot masturbate,
then an alternative option is to collect the semen sample
produced during nocturnal ejaculation ( wet dream) ,
and take this to the IVF lab for freezing. Ideally,
rather than scoop it up from your underwear or the bed
sheet, this should be collected in a silastic condom
( which you’ve put on when going to sleep). Since
IVF labs are not open in the middle of the night, you
may have to transfer the semen into a special medium
called egg-yolk medium( which you’ll have to buy
from the IVF clinic) and keep it in your refrigerator
freezer. The sperm retain their viability in this special
medium for many hours, and you can then take it to the
IVF lab the next day morning.
Let’s now look at the worst case scenario. Let’s
suppose you find you are in the clinic, the eggs have
been collected, and you cannot produce a sample . Don’t
panic – there is a lot which can been done to
help you. Firstly, stop trying – the increasing
anxiety will just make a bad situation worse. You need
to break the cycle, and going out for a walk can help,
so you come back recharged and refreshed. We have found
that sometimes giving the man a sedative and allowing
him to sleep helps him to produce a sample once he wakes
up. However, if time is limited, this may not be a realistic
choice. In such cases, we have found that using a vibrator
can help men to stimulate themselves. We have a heavy-duty
electrically operated vibrator in the clinic, and we
instruct the many to apply this to the frenulum, until
he ejaculates. It can take upto 10-15 minutes before
he ejaculates, but this very rarely fails. We often
given these men 100 mg of Viagra, to help them get an
erection before using the vibrator . If the penis is
sore because of excessive friction and stimulation,
using liquid paraffin as a lubricant can also help.
Very rarely, if this fails, then we have had to resort
to more extreme measures. We now have 2 options available
which we can offer patients who fail to ejaculate.
The first is a technique called electroejaculation,
in which a rectal probe is introduced under general
anesthesia through the anus, to electrically induce
ejaculation. The other option is testicular sperm aspiration
( TESA,
) , in which sperm are sucked out from the testis, and
used for intracytoplasmic sperm injection (ICSI)
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