Male infertility: causes and treatment options
Although infertility is still often seen as a “women’s issue”, the cause of unwanted childlessness is just as likely to be in the woman as in the man.
Male infertility: causes and treatment options
In the following article, we look at the causes of male infertility and describe how you can fulfill your desire to have children despite a possible diagnosis.
Infertility: General information
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 . 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 .
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 .
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.
Possible cause of male infertility: sperm quality
According to the current state of knowledge, a whole range of possible causes for infertility in men could be proven: The spectrum is broad and ranges from genetic defects to external influences. While the latter affect both sexes equally, there are genetic and health problems that only affect men.
One of the most common causes of male infertility is the so-called oligo astheno teratozoospermia syndrome (OAT syndrome) — a pathological change in sperm quality. This is caused by a combination of the following three factors:
- Oligozoospermia stands for a low number of sperm in the ejaculate. The healthy value is around 20 million per millilitre of seminal fluid.
- Asthenozoospermia occurs when there is less motility of the sperm in the ejaculate.
- Teratozoospermia indicates malformed sperm. According to WHO criteria, it occurs when less than 30% of the sperm cells have a mature form.
In order to fertilize a female egg, the sperm must not only be motile and mature, but also be present in the ejaculate frequently enough. However, if OAT syndrome is diagnosed, there is a defect in the production of healthy sperm or a disorder in their transport.
Other cause of male infertility: sperm transport
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.
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.
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.
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 .
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)
Male infertility: Possible examinations
Nowadays, it is fairly easy to determine whether unwanted childlessness is caused by reduced sperm quality or impaired sperm transport. And yet a urological examination becomes a problem for many men.
For generations, male fertility has been considered something given and is very much associated with the idea of actual masculinity. While women often reflexively look for the cause of childlessness in themselves, men are significantly less willing to see a doctor and engage in an examination .
However, if the man decides to have a medical examination, he should consult a urologist. After a detailed medical history, a series of tests are carried out to check the presence and quality of the sperm cells.
- Spermiogram: A detailed examination in which the ejaculate is examined in the laboratory. This gives an accurate picture of the number, motility and shape of the sperm.
- Hormone status by means of a blood sample.
- Examination of the genital organs, prostate and urinary tract by means of palpation and ultrasound.
- Surgical testicular biopsy: If no exact reason is found or no sperm can be found in repeated ejaculation tests, the patient’s testicular tissue is removed and examined for sperm.
Treatment options for male infertility
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.
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.
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.
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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