According to the who one can speak of reduced fertility where no con­ception has occurred after one year of frequent and unprotected inter­course. It is not completely clear what is meant by frequent. Eels mate once in their lives, taking a long time to become sexually mature. Many of these fish are over eighteen years old when they have sex for the first and last time somewhere in the shadowy depths of the Bermuda Triangle. After depositing their sperm or eggs, they die.

Although the vast majority of human couples see their wish for pregnancy fulfilled within a year, there remains a group with reduced fertility. The majority will eventually achieve a spontaneous pregnancy and a small percentage will remain involuntarily childless. The cause of reduced fertility may lie with the woman, the man or both simultan­eously. A large who study showed that in 39 per cent of cases the cause of involuntary childlessness lay with the woman, in 20 per cent with the man and in 26 per cent with both partners. In 15 per cent no cause can be found.

Systematic and standardized examination of a woman with reduced fertility is carried out by a gynaecologist, and in the case of men by a urologist with a particular interest in this problem, who in most European countries is called an andrologist. Causes of reduced fertility include: inability to achieve an erection or a sufficiently hard erection, inability to ejaculate, a varicose vein, an obstruction due to sterilization or inflammation of the epididymis, absence of seminal ducts, hormonal problems, certain medications, undescended testicles and inflammation of the prostate. In many cases the cause unfortu­nately remains unknown.

There is no better characterization of reproductive problems than that given by the biologist Midas Dekkers:

First you have to negotiate with some woman. You have to in­troduce yourself, say what you earn, what your father does. . . you can’t buy an ovum anywhere. There’s a whole tea cosy built around an ovum and the tea cosy doesn’t want me to go anywhere near her ovum with my sperm. So I have to negoti­ate with her, dance with her, maybe even take dance classes. . . if that goes well and you’re allowed to get to grips with her, there are millions of sperm at the start line ready for the off. Then we find that we as men should be ashamed of ourselves, since of all those sperm not one usually reaches its destination.

The sperm we produce is totally shit sperm.

Investigation to determine the cause of male subfertility (‘shit sperm’) begins with questions about sexual development, illnesses, use of medication, smoking habits and external factors such as contact with toxic substances or frequent and protracted exposure to high temper­atures. In addition attention will be paid to family illnesses and genetic disorders in the man or his partner. Various diseases are associated with fertility problems and if an unfulfilled desire for children is successfully treated they may be transmitted. Olfactory disorders and abnormalities in vision may be associated with a defect in the pineal gland (hypophysis). A number of genetic diseases are associated with a typical physical build, which will be immediately recognized by an experienced doctor. The patient will also be asked about certain personal habits: thermal underwear, use of saunas, intensive practising of sport, excessive alcohol use – all examples which may adversely affect fertility. The physical examination begins with looking at possible signs of breast formation, the pattern of hair growth and the measuring of height and weight. The examination of the groin area, penis, testicles, epididymides, seminal ducts and prostate is the counterpart of the gynaecological examination. There will also be a check for any variocele, which must be carried out with the man in standing position. Additional examination includes repeated exami­nation of sperm – abnormalities found on one occasion need not be significant, since that could caused even by a flu bug – and hormone tests.