Male in­fer­ti­lity: causes and tre­at­ment op­tions

Ac­cor­ding to the World He­alth Or­ga­ni­sa­tion (WHO), if a couple does not be­come pregnant wi­thin a year de­spite re­gular un­pro­tected sex, they are con­sidered in­fer­tile [1]. This pro­blem is wi­de­spread. In the Eu­ro­pean Union, ac­cor­ding to the Eu­ro­pean So­ciety of Human Re­pro­duc­tion and Em­bryo­logy (ESHRE), 25 mil­lion ci­ti­zens are in­vol­un­t­a­rily child­less [2].

There are va­rious re­asons for this, which can have an ef­fect on the cou­ple’s in­fer­ti­lity either in­di­vi­du­ally or in com­plex con­texts. At this point, we would like to dispel a common as­sump­tion: alt­hough in­fer­ti­lity is still often seen as a “wo­men’s issue”, the cause of in­vol­un­tary child­less­ness is just as li­kely to co­here with the woman as with the man [3].
In the fol­lo­wing ar­ticle we look at the causes of male in­fer­ti­lity and tell you how you can fulfil your de­sire to have children de­spite a pos­sible dia­gnosis.

Sperm trans­port is said to be dis­turbed when the testicles pro­duce en­ough func­tio­ning sperm, but these cannot reach the out­side be­cause of a da­maged or blo­cked vas de­fe­rens. This re­sults in an eja­cu­late with a very low sperm count. In turn, re­duced sperm qua­lity or a da­maged trans­port pa­thway can be caused by a number of fac­tors.

Un­de­s­cended testicles

A mal­for­ma­tion that can occur du­ring child­hood. If a child’s testicles have re­mained in the ab­do­minal or in­guinal area and have not mi­grated down into the scrotum, this is called un­de­s­cended testicles. Thanks to the high body tem­pe­ra­ture, the sperm in the testicles be­come over­heated and lose qua­lity.

Hor­mone dis­or­ders

While this cause is less common in men than in women, it can still lead to in­fer­ti­lity. In this case, the pro­blem is due to a de­fi­ci­ency of the hor­mones FSH and LH, which are re­spon­sible for both tes­to­ste­rone pro­duc­tion and the for­ma­tion of new sperm in the testicles.

Age

It is ra­rely said, but the bio­lo­gical clock is ti­cking in men too. Ac­cor­ding to the Fe­deral Mi­nistry for Fa­mily Af­fairs, the ma­jo­rity of men are sure to re­main fer­tile until they are 65. Bet­ween the ages of 40 and 50, only 8% of men su­spect that their own fer­ti­lity could be li­mited by their age [4].

Ex­amples of men who be­came fa­thers in old age rein­force their be­lief, so they are often serene about their own fer­ti­lity. The good news is that men pro­duce sperm th­roug­hout their lives. Ho­wever, sperm qua­lity de­clines with age, which can be a trigger for in­fer­ti­lity, among other fac­tors. It has been found that the number of motile sperm de­creases by about 1% per year of life. In ad­di­tion, the age of the fa­ther is also po­si­tively as­so­ciated with a number of ge­netic mu­ta­tions and di­se­ases in the child. Thus, late fa­ther­hood can lead to chro­mo­somal ab­nor­ma­li­ties and di­se­ases such as au­tism or schi­zo­phrenia.

En­vi­ron­ment and life­style

As men­tioned ear­lier, these fac­tors can con­tri­bute to both fe­male and male in­fer­ti­lity. These in­clude:

• Me­di­ca­tions (for ex­ample che­mo­the­rapy).
• Ana­bolic ste­roids
• Psy­cho­lo­gical and phy­sical stress
• Al­cohol and ni­co­tine abuse
• En­vi­ron­mental to­xins
• Wrong diet and the re­sul­ting di­se­ases (dia­betes, obe­sity)

De­pen­ding on the re­ason for in­fer­ti­lity, there is a wide range of tre­at­ment op­tions available to those af­fected. These in­clude:

• Hor­mone the­rapy for hor­mone de­fi­ci­ency
• Sur­gery of the da­maged vas de­fe­rens
• Psy­cho­the­ra­peutic sup­port for psy­cho­lo­gical fac­tors such as phy­sical and emo­tional stress

In ad­di­tion, se­veral op­tions for as­sisted re­pro­duc­tion are of­fered.

Ho­mo­logous in­se­mi­na­tion

A type of fer­ti­li­sa­tion in which the man’s sperm cells, pre­pared in a la­bo­ra­tory, are in­serted into the cervix, the uterus itself or the wo­man’s fallo­pian tubes. Since fer­ti­li­sa­tion hap­pens wi­t­hout se­xual in­ter­course, it is con­sidered ar­ti­fi­cial. But both part­ners are bio­lo­gical par­ents of the child.
This type of as­sisted re­pro­duc­tion is useful if the man’s sperm are too few in number and/or too im­mo­bile.

He­te­ro­logous in­se­mi­na­tion

If the pro­crea­tive power of the partner is not suf­fi­cient for as­sisted re­pro­duc­tion, pregnancy can still be achieved with the help of he­te­ro­logous in­se­mi­na­tion. In this me­thod, for­eign sperm cells from a sperm donor are ar­ti­fi­ci­ally in­serted into the wo­man’s body.

In vitro fer­ti­li­sa­tion (IVF)

This common me­thod of ar­ti­fi­cial in­se­mi­na­tion in­volves fer­ti­li­sa­tion in a test tube, in which the sperm cells pre­viously coll­ected from the man and the wo­man’s eggs are brought tog­e­ther. Un­like the above-men­tioned me­thods, fer­ti­li­sa­tion takes place th­rough the sperm cells them­selves. The fer­ti­lised egg is then im­planted into the wo­man’s uterus. It is not easy to struggle with un­wanted child­less­ness.

The cost of ar­ti­fi­cial in­se­mi­na­tion is high. It is an ela­bo­rate pro­cess that can be fi­nan­ci­ally, tem­po­rally and emo­tio­nally stressful. Each of these me­thods has its ad­van­tages and di­s­ad­van­tages, which should be dis­cussed and weighed up tog­e­ther with the doctor trea­ting you. One thing is cer­tain, ho­wever: there are en­ough pos­si­bi­li­ties to fight for your child wish and to make it a rea­lity. You should seek help from spe­cia­lists, for ex­ample in a fer­ti­lity clinic. Under cer­tain con­di­tions, the he­alth insu­rance com­pany will cover part of the costs. In ad­di­tion, some fe­deral states offer fi­nan­cial sup­port for those who wish to have children.

At Fer­tilly, we have made it our mis­sion to ac­com­pany cou­ples (ho­mo­se­xual and he­te­ro­se­xual) and sin­gles on the way to ful­fil­ling their child wish. In doing so, it is im­portant to us to create trans­pa­rency in the area of fer­ti­lity ser­vices, to pro­vide in­for­ma­tion and know­ledge on the to­pics of pregnancy and fer­ti­lity and to help you to find the most sui­table Fer­ti­lity Center. Th­rough co­ope­ra­tion with first-class Fer­ti­lity Cen­tres and cli­nics in Eu­rope, en­qui­ries about Fer­tilly are given pre­fe­ren­tial tre­at­ment. This means that our pa­ti­ents avoid the usually long wai­ting times and get ap­point­ments more quickly.

If you would like more in­for­ma­tion about Fer­ti­lity Cen­ters, suc­cess rates and prices, please contact us using this ques­ti­on­n­aire. We will ad­vise you free of charge and wi­t­hout any ob­li­ga­tion.

Sources:

1. World He­alth Or­ga­niza­tion (2016) — https://www.who.int/reproductivehealth/topics/infertility/multiple-definitions/en/
2. Eu­ro­pean Po­licy Audit on Fer­ti­lity. ESHRE (2018). https://www.eshre.eu/-/media/sitecore-files/Publications/Strasbourg-2018/01_RAUTAKALLIO_new.pdf?la=en&hash=1770B7CF593AE4B0EE69076C244407F6C0062596
3. Kumar, N & Kant Singh, A (2015): Trends of male factor in­fer­ti­lity, an im­portant cause of in­fer­ti­lity: A re­view of li­te­ra­ture. In: Journal of Human Re­pro­duc­tive Sci­ences. 2015 Oct-Dec; 8(4): 191–196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691969/
4. Bun­des­mi­nis­te­rium fuer Fa­milie (2013): Delta-In­stitut-Kin­der­lo­sen­studie. https://www.bmfsfj.de/blob/94130/bc0479bf5f54e5d798720b32f9987bf2/kinderlose-frauen-und-maenner-ungewollte-oder-gewollte-kinderlosigkeit-im-lebenslauf-und-nutzung-von-unterstuetzungsangeboten-studie-data.pdf