“Male Factor Infertility” in 1950
In 2008, after two years of failing to make a child organically, we learned the doom Kathy had already been feeling for more than a year was justified: I was diagnosed with male-factor infertility. Our only real chance to move forward would be in vitro fertilization. We couldn’t afford it; we couldn’t afford not to do it. One way we tried to work through that diagnosis, our anger, and our options was to start a secret infertility blog, “Less Than a Million.” This post and what comments from 2008 that are attached to it come from that blog.—gb
Following from my previous post, Marsh and Ronner review the 1950s:
Clinicians … faced three major difficulties in the 1950s in treating male sterility. First was simply getting men into the examining room. Since the late-nineteenth-century practioner William Goodell first begged his colleagues “in the name of humanity as well as science” not to operate on women before they had examined their husbands, physicians who specialized in infertility treatment deplored the fact that women often underwent treatment when their husbands were infertile. But the fact was that women were the ones who sought treatment, that most practitioners in the field came from gynecology, and that husbands proved elusive creatures when it came to having their genitals probed or their semen examined. One young wife, after her first visit, alone, to an infertility clinic, admitted that her husband simply refused to be examined himself, although he said he wanted children. “I can’t force him,” she said. “Rather than risk breaking up our marriage, I’ll go without a family.” Others told the same story. To get a man to cooperate, physicians appealed to his love for his wife, reminding him that tests for male infertility required much less invasive procedures, that sometimes a semen sample was all that was required. Of course, should that semen sample reveal a low sperm count or other abnormality, further tests ensued. A few men took the initiative, although when a husband rather than his wife called one infertility clinic in the mid-fifties, the staff took that a sa signal that the wife might not really want to be a mother.Second, there was profound disagreement among experts as to what actuall constituted male infertility. Everyone agreed that a man with a seminal emission of more than 2.5 cubic centimteres, a sperm count of at least a hundred million sperms per cubic centimeter, with a high proportion of the sperm active and normally shaped, was fertile. And they agreed that a man with no sperms at all was sterile. But in between, disputes abounded. When the American Society for the Study of Sterility had attempted to standardize diagnosis by providing guidelines in the late 1940s that set the fertility standard at sixty million sperms with 60 percent active and 75 percent normally shaped, such definitions met resistance. Some clinicians believed that infertility started at eighty million sperms, others argued for forty, and a few insisted that a man with only twenty million sperms per cubic centimeter, as long as most of them were normal and active, was fertile.
Third, therapeutic disputes abounded. For years, physicians agreed that azoospermia was untreatable, except in rare cases in which sperms were produced but their passage had been blocked. Oligospermia (inadequate sperm count) was a different matter, and many did believe it could be treated. The usual therapies were those advocated in the 1930s: regular rest and exercise; abstention from alcohol, tobacco, and caffeine; a healthy and varied diet; avoidance of “sexual excess”; reduction of stress; decrease in exposure to lead, automobile emissions, and ex-rays; and thyroid therapy. When New York physician Abner I. Weisman decided to determine the efficacy of a treatment that combined these measures, however, he found himself stymied. Out of six hundred men that Weisman treated and followed up for two years, only three pregnancies resulted. Soon, physicans would be giving men one benign new recommendation—to switch from jockey to boxer shorts—while also subjecting them at the same time to new experimental therapies using testosterone and gonadotropic extracts from animal sources.
