The list of drugs and procedures that have been tried is endless but none of them have been scientifically validated to lead to effective improvements in sperm count. Some of these empirical treatments which have been tried without demonstrable success include the use of hCG, hMG or anitoestrogen therapies (clomiphene citrate, tamoxifen), testosterone administration, Testolactone, Bromocriptine, Kallikrein, Pentoxyfylline and artificial insemination with the husband’s sperm.

There has also been a lot of interest in the use of vitamins and mineral supplements such as vitamins E, C and Zinc. Vitamin E at moderate doses might reduce reactive oxygen species and be beneficial to some men and vitamin C apparently reduced agglutination(clumping together of cells) in numerous clinical trials. Although zinc concentrations are reduced in the seminal fluid of men with chronic infections of their prostate glands, supplementation with zinc does not appear to improve fertility.

Although studies have reported improvements in semen parameters’ following ligation of varicocoeles there has been no evidence of improvements in fertility subsequently. This means that even though we try a lot of treatment and operations, there is no effective treatment for male infertility and most couples remain childless unless they are able to achieve a pregnancy by themselves.

This was the situation until 1992 when the revolutionary technique of intra-cytoplasmic sperm injection (ICSI) was reported by Van Steirteghem and colleagues in Brussels. The objective of ICSI is not to cure the problem but to achieve a pregnancy despite the abnormalities. ICSI involves the picking up of a single sperm cell and using powerful microscopes to inject it directly into the egg. This process that is carried out outside the body during in-vitro fertilisation (IVF) leads to fertilisation of the egg which can then be cultured in the laboratory for transfer.