Some men find it difficult to produce a sperm sample 'on demand' during infertility treatment. Learn how we help patients overcome this in a variety of clever ways.

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 !

Funny, but true

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

The reason

There are many reasons this can happen:

• Many men need their wife to help them to produce a sample
• 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 !

The pressure is on

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.

Things you can do

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.

f 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.

Freezing sperm

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 In Vitro Fertilization 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!

The alternative

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 In Vitro Fertilization 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.

Getting rid of anxiety

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.

The last resort

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)