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Have one testicle. Trying to impregnate my wife, but not getting success. What to do?

Mar 2013
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infertilityI am 30 years old, when I was about 11 I lost one of my testicles, it went up to my abdomen and never came back down.. my wife and I have been trying to get pregnant for the past 5 years without having any luck, I fear it hasn't happened due to me missing my testicle. could this be the reason why? what can we do or what type of doctor should we be looking for?
Posted Sun, 24 Mar 2013 in Infertility Problem
Answered by Dr. Aarti Abraham 22 minutes later
Thank you for your query.

There could be reduced semen production as a result of having only one testicle, but fertility is not affected in most cases. Let’s take a look at this in numerical terms. Sperm production in excess of 20 million per sample is considered normal. If a man produces 100 million sperm with two testicles and that number is cut in half due to the loss of one testicle, sperm production is still within normal levels.

So please do not worry on that score. However, at times, if the remaining testicle is not functioning properly due to some reason, you could have subfertility.

Trying unsuccessfully for conception since 5 years is a major issue. Please follow the following pointers :

1. Maintain an ideal BMI - applies to both you and your wife. Exercise regularly, cut down on processed, oily, fatty foods. Have lots of fresh XXXXXXX vegetables, fruits, nuts, whole grain cereals. Make sure your wife is taking folic acid supplements. Be aware of the natural menstrual cycle, the days of ovulation, and proper coital technique. Avoid smoking / drinking / erratic hours / stress / drugs - all these are detrimental to fertility.

2. Consult a reputed Fertility Specialist in your area. Have a detailed counselling regarding your family history, medical history, sexual history, personal history etc. Get your basic blood investigations done - blood grouping, viral markers, renal and liver function tests, blood sugar levels, lipid profile , infection profile, screening for tuberculosis etc ( if in endemic area ) etc for both of you.

3. Have your semen analysis done at a reputed laboratory suggested by the doctor - after 3 days of sexual abstinence. This report, if essentially normal, rules out any cause of not conceiving from your side.

4. Have complete hormonal profile of your wife done - thyroid hormones, reproductive hormones on day 2 of the cycle such as FSH, LH, serum estradiol, Serum progesterone on day 21, etc.

5. Make sure your wife is ovulating. Her ovarian reserve ( capacity to produce mature and good quality and number of eggs ) will be determined by tests like AMH ( anti mullerian hormone ) and a baseline ultrasound on day 2 of periods which will give her AFC ( antral follicular count - number of eggs in resting condition in both ovaries ). The best way to document ovulation is by having a serial follicular monitoring during the menstrual cycle, by transvaginal ultrasound, and confirm her ovulation.

6. If all these tests are normal, you can then try for 2 - 3 cycles of natural relations or follicular monitoring with fertility medications. If this does not yield any result, I would advise a tubal patency testing , such as a diagnostic laparoscopy , which will assess whether the fallopian tubes of your wife are open and functioning well. You can go for a HSG ( hysterosalpingogram ), which is an X XXXXXXX and less invasive than laparoscopy, before beginning any treatment, but a laparoscopy is more reliable and preferred after 5 years of trying.

7. Please remember that almost 30 % of cases of infertility are unexplained, even after intensive testing. Semen production, egg production, ovulation, fallopian tube patency, and intact uterine endometrium ( lining ) to receive the fertilized ovum, are all integral parts of conception. All of them need to be tested.

Please do not worry on the single score of one testicle, as most men with one testicle go on to father children.

Please consult a Fertility Expert at the earliest.
Meanwhile, remember that positivity and lack of stress are most important for planning a pregnancy.

I wish you all the best, and please feel free to ask me any further questions.
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