I recently reviewed two 30-year-old men who I have been managing for infertility.
They both had mumps orchitis as children, and this is perhaps a little-known complication of the viral disease, which can cause acute inflammation and then severe scarring of the testicles rather than the salivary glands.
Neither man had any sperm in their ejaculate and both had borderline testosterone end elevated serum gonadotrophin levels, suggesting severe damage to the testicles. Medication to boost sperms and testosterone (clomiphene) had no effect on the sperms but did elevate their testosterone.
In one of the men, we were lucky enough to find little pockets of sperm among the scar tissue using the technique of microscopic TESE (where we open up the testicles under anaesthetic and use a microscope to find the most promising sperm tubules). But in the other man, no sperm at all were found.
The first man now has a pregnant wife with three embryos in the freezer, and I hope the couple have a long and happy family life together. Sadly, for the other man, he will never be able to have his own children, will have a lifetime of testosterone replacement therapy, and his only option for children will be adoption or using a sperm donor.
I must declare an interest here, since I have a son with autism who is nearly 30 and thus born at the height of the vaccine scare created by Dr Andrew Wakefield. Wakefield was a man who in 1998 published what is now accepted as a fraudulent paper, looking at the MMR (measles, mumps and rubella) vaccine and linking it to autism. In 2010, a review found that this was almost certainly fraudulent research, and the paper was taken out of publication, with Dr Wakefield then being struck off the medical register.
Vaccination rates in the UK went through the floor after the claims of a link between the MMR vaccine and autism, and many boys, including my two patients, did not receive the vaccine due to their parents’ fears. My own son was vaccinated and I did not believe then, nor do I now, there are any links between that vaccination and autism.
Vaccination, along with clean water, is one of the most important medical advances we have ever seen and is certainly much more important in saving lives and disability than any of the surgery I have ever done. No treatment is ever 100% safe but common vaccinations prevent many more problems than they cause.
It is always tragic when avoidable harm happens to patients, as in in these men.
What is perhaps as impressive is that even men who have no sperm on testing can often become fathers.
However the message here is: do vaccinate your sons and do not lead them to this potential harm, which they will not discover until they are adults.