Infertility of men

Nicole Wendler holds a PhD in biology in the field of oncology and immunology. As a medical editor, author and proofreader, she works for various publishers, for whom she presents complex and extensive medical issues in a simple, concise and logical manner.

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The man's sterility can be to blame for the unfulfilled desire to have children - just as often as the woman's sterility is the cause. If male sterility is mentioned, the man is incapable of childbearing. Mostly the testicles are then at the center of the cause research. Read here what can be behind the inability to conceive and how a man's desire to have children can be fulfilled despite infertility.

Causes of Male Infertility

An unhealthy lifestyle (obesity, nicotine, drugs, alcohol, stress) and harmful environmental influences (pollutants, pesticides) damage the fertility of men and women alike. However, there are gender-specific differences in the physical causes.

An infertile man usually does not produce enough healthy, motile sperm. This is what a sperm test reveals, in which a spermiogram is created:

Normally, every milliliter of sperm fluid (ejaculate) contains at least 15 million sperm - one of the prerequisites for a child's father to work. But the amount alone does not make it: at least 58 percent of the sperm must be alive (vital), at least 32 percent well mobile and at least 4 percent normal. Here you can find out what else belongs to a "normal" semen analysis.

If there is enough good quality sperm, it ultimately needs a free transport route - from the testicles to the epididymis and then via the spermatic duct to the outside, made possible by an ejaculation.

Male infertility due to poor sperm quality

If a man is unable to reproduce, it is often due to the poor quality of his sperm. Sometimes there are not enough sperm in the ejaculate (oligozoospermia) - either because the production or the transport of the sperm cells is not functioning optimally. It can also be that too few sperm are motile (asthenozoospermia) or too many sperm are malformed (teratozoospermia). Some infertile men have all three problems at the same time. Then doctors speak of the OAT syndrome (oligo-astheno-teratozoospermia).

But even if there are enough sperm and they appear fit and fast at first glance, men can still be sterile - namely when a modified gene prevents the sperm from making it through the uterine mucus.

Incidentally, as with women, age also plays a role in fertility in men: the older you are, the fewer and slower your sperm cells become.

Decreased sperm production

Only intact testicular tissue produces fertile sperm. Numerous factors, which sometimes already exist at birth or in toddlerhood, can damage the testicles and limit semen production and thus fertility in men in adulthood:

Inflammation of the testicles due to mumps (mumps orchitis) or other infections (e.g. chlamydia)
congenital malformation (e.g. undescended testicles)
Hormone deficiency: too little male hormone (testosterone) due to underactive testicles (hypogonadism), which usually also reduces the libido
genetic abnormalities (e.g. Klinefelter syndrome: man has two X chromosomes, too little testosterone)
Tumor disease or treatment (e.g. testicular cancer, chemotherapy)
Operations (e.g. on the prostate)
Injuries (e.g. testicular torsion)

Permanently overheated testicles are also damaged. If the temperature in the testicles increases to over 32 degrees Celsius due to varicose veins (varicocele), circulatory disorders, undescended testicles, special sports or workplace conditions, the amount of sperm decreases.

Disturbed transport route

Sometimes a sticky or severed vas deferens prevents the sperm from arriving (obstructive azoospermia). Triggers for this form of male sterility can be:

Infections (e.g. chlamydia)
Inflammation of the testicles, epididymis (orchitis, epididymitis) and prostate (prostatitis)
Urethral constriction
Surgery (inguinal hernia)
Cystic fibrosis (cystic fibrosis)
congenital malformation

Other causes of male infertility

Inadequate urinary bladder occlusion (retrograde ejaculation), so that the ejaculation ends up in the bladder (in the urine). Possible causes: surgery, diabetes, nerve damage, enlarged prostate
Immunological sterility: antibodies against one's own sperm
Hormone changes: lack of testosterone, disorders affecting thyroid or pituitary hormones
Taking anabolic steroids (bodybuilding)
Mental health: Stress can negatively affect libido and sperm quality.
Erectile dysfunction (impotence)

Signs of infertility in men

Except in the case of functional sexual or erectile dysfunction, the inability to conceive is usually not physically noticeable in men. However, the first signs that male infertility is developing may include weight gain or loss and swelling of the testicles. Discharge from the penis or pain when urinating or in the testicles indicate an infection that can affect fertility.

Male infertility: diagnosis

If the gynecologist is the contact for female sterility, the urologist or andrologist diagnoses male infertility. The man has to undergo a few examinations before the diagnosis:

Examination of the genital organs
Assessment of hair / physique
Ultrasound of the testicle
Ejaculate examination (semen analysis)
Hormone level measurements (via blood tests)
Testicular biopsy

Male infertility: therapy

If conception does not work immediately, you should check your lifestyle habits: a healthy diet, diet, exercise, abstinence from nicotine and alcohol as well as reducing stress can improve a poor semen analysis.

Getting the right amount of sex is also important: intercourse every three days seems advisable if you are having trouble conceiving. Daily sex, on the other hand, does not increase the chances of success, but rather reduces the number of sperm in the ejaculate.

If a physical cause is found, treatment is based on it. It should be done after detailed consultation of the patient by an experienced urologist / andrologist or at a specialized fertility center. There are the following options:

psychotherapeutic treatment
Surgery for varicose veins on the testicles or sticky vas deferens
Antibiotic treatment for bacterial infections such as chlamydia (also for the partner)
drug treatment for hormone deficiency or erectile dysfunction
Vacuum pump
Penile implant

If these measures do not help, doctors support the sperm on their way to the egg cell:

Seed extraction

If the sperm are fertile and just can't find their way out, you can think about a testicular sperm extraction (TESE, "testicual sperm extraction"). The sperm are removed from the testicular tissue by means of a testicular biopsy.

New techniques with which mature sperm can be identified (PICSI, "physiological intracytoplasmic sperm injection") or less suitable sperm can be sorted out (IMSI, intracytoplasmic morphologically selected sperm injection), promise better chances of success in the case of infertility. In this way, men and women can often be helped to have the offspring they long for.

Artificial fertilization

With the sperm selected in this way, various techniques of artificial insemination (assisted reproductive technology, ART) can be used to fulfill the desire to have children:

Intrauterine insemination (IUI): transferring semen into the uterus
In vitro fertilization (IVF): test tube fertilization
Intracytoplasmic sperm injection (ICSI): Special form of IVF, sperm is injected directly into the cytoplasm of the egg cell under the microscope
Artificial insemination using sperm donation

Male Infertility: Common Path

The diagnosis of infertility puts a strain on the couple. Whoever triggers infertility - men and women should agree on the decision for sterility treatment and want to walk this path together. Understanding, patience and open conversations are particularly important during this time. Professional psychological support can increase the success of therapy in the case of male infertility.

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