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Sperm fertilizing ovum.

Yet decades passed before urologists made the kind of discoveries that are truly helping today's infertile men father children. In 1929, physicians Donald Macomber and Morris B. Sanders highlighted the importance of sperm counts in the diagnosis and treatment of male infertility. In his 1951 landmark study, Cornell University's John McCloud, PhD, suggested that semen quantity and quality were controlling factors in conception and that high counts and healthy sperm made for better results.

While some investigators were establishing these basics, others were investigating the mechanisms of testicular failure. In June 1940, urologist Charles W. Charny from Philadelphia showed that biopsies and microscopic tissue studies could reveal the function of the testicles and, particularly, the function of the thread-like seminiferous tubules that produce and transport sperm within the testes.

By 1955, Scottish surgeon W. Selby Tulloch had suggested that enlarged varicose veins around the testicles in some men could hurt sperm production. Surgery to correct the problem was one of the first solutions urologists had to offer infertile men once they understood the association of impaired sperm

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