Too Hot To Handle
Some years ago, a milled-aged couple came to see me. The husband and wife must have both been in their mid-thirties. Both looked apathetic and listless. I couldn’t understand why anyone looking like that would voluntarily seek andrological consultation. You on the fast guys and other seminal matters , andrology is a quality of life (QOL) specialty are in medicine. Those who don’t have any interest in life and living in the first place are hardly likely to care much about its quality. Hence, andrology didn’t seem at all to fit in with this couple’s demeanour.
I thought that these people had made a mistake somewhere. They looked more like lambs being led to a slaughterhouse than like my usual patients. I was almost tempted to tell them that mine is not an intensive care unit or a mortuary, so that they would realize their blunder and go away. To add to my bewilderment, the man was carrying an enormous suitcase. I suspected that he might have even paid excess baggage for it, that’s how awesome it looked. I was dying to know what it contained. He probably thought that I was a cardio-thoracic surgeon and had brought along my fees for a coronary bypass operation or something, I figured, using deductive logic.
The mystery was getting deeper and deeper.
Even though I asked them several times to sit down, the Despondent chose to remain standing. Again, I got the distinct impression that they had regretted coming here. It appeared that a part of them was contemplating turning around and bolting through the door.
Eventually, after what seemed like an eternity, they made up their minds to stay and sat down abruptly. I started at the ceiling, and waited, anything happens in this world, I told myself. Only, here it was happening to me.
‘We have given up hope, doctor,’ the husband finally uttered.
‘Can we at least discuss the problem before jumping to hasty conclusions?’ I recommended.
I expected him to tell me about the heart attack he had suffered and about the coronary passage to manhood operation he wanted me to perform.
‘Well, doctor, let me summaries it for you,’ the wife butted in. ‘We’ve been trying to have a baby for six years now, right from the time we got married. For the first four years, we tried diligently, but to no avail. Then we started seeing doctors. Over the past two years. We’ve visited several and have had eight attempts at IUI (intra-uterine insemination) and three attempts at IVF (in vitro fertilization- test tube baby). As you can see, they have all been failures. We’re tired of scans, semen analyses, injections and medicines. We’ve spent lots of money, and both of us, being working people, have gain one organ, lose another a lot of leave and pay too. We just want to know whether to give up hope altogether or whether it makes sense for us to continue to try . just tell us bluntly, doctor. My husband has reached a stage where he now can’t even have sex or collect a sample of semen on the desired date any more. How much semen they’ve taken out of my poor baby!’
‘At least he’s not going to get a heart attack in my office and die right here and now,’ I thought to myself, with a sigh of relief. Semen loss and infertility are easy.
‘I see what you mean,’ I said, understandingly.
examinations and tests had been done. The man was simply handing over semen samples to the fertility center whenever required. To me, all this seemed less like human husbanding and more like animals husbandry. I couldn’t believe it! This was supposed to be the best center in their town. But I didn’t say anything. No point rubbing it in, I thought. They were feeling lousy enough already.
I studied his papers for the next several minutes and then did what I usually do when the facts are overwhelming. I start from the very beginning. I requested the wife to step out for a few minutes saying that I wanted to examine the gentleman. I have never understood the absurd logic behind this strangely Indian medical customs. This couple has been trying to make a baby for six years now, yet I’m asking the lady to leave the room now in the interest of modesty! Corny, but that’s how it is usually done in this part of the world. The wife left the room hastily too, with head bowed down in a classical display of Indian feminine hypocrisy. It was almost like she was saying, ‘if the lights are on, I’m out; if the lights are out, I’m on’.
The Indian woman, it appears, is a creature of the night, like Laura Brannigan.
I told Despondent that nature has intentionally placed the testes (testicles ) outside the body. This is because the core of the human body is hot and, if the tests remain inside there, hey cannot produce sperms. The tests need a lower (cooler) temperature in order to produce sperms. By placing the testes outside the body, it is possible to reduce the temperature by three to five degrees Celsius. This is why humans and some mammals have their testes outside their bodies, I explained, and told them how the testes travel all the way from near the kidneys to their final destination in the scrotum, just for his purpose.
‘Yes, yes, doctor, now I have understood everything. I have seen testicles hanging out and bouncing up and down in dogs and horses also. Am I right?’
‘Absolutely,’ I said, thinking him to be rather astutely observant. I continued.
‘Oh, I see,’ said Mr Despondent. ‘This means that the testes becomes very hot and cannot produce sperms properly, just like how we cannot work properly in the office without air conditioning . am I right, doctor?’
I nodded and continued. This man was a lot of more brilliant than I had imagined.
Since Mr Despondent had tried every conceivable medicine for conceiving, I unhesitatingly advised him to undergo a microsurgical varicocelectomy operation after conducting a few perfunctory tests. I was the pioneer of this kind of surgery in India and had a large experience, I told them, by way of sales pitch.
‘We know doc,’ they chorused. I didn’t want to embarrass myself by asking them why they hadn’t come to me much earlier in the first place then.
The operation was performed under spinal anaesthesia one fine morning, and Mr Despondent left the hospital the same evening .
I always feel on top of the world when babies are conceived in the bedrooms rather than in the laboratory.
Take Home Message:
It is lamenstable and unfortunate fact that, since the advent of assisted reproductive technologies (ART) and IVF –ICSI, male factor evaluation often gets left out at many infertility centers. It is only the semen sample that gets examined, not the man. Since the male factor omission, as many causes of male infertility are treatment must insist on an andrological evaluation of the male partner.