Jenia Chor­naya

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 [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.

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.

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)

 

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 [4].

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.

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.

About Fer­tilly

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.

  • An­swer the first ques­tions in the on­line form in order to book an ap­point­ment. This way we can better ad­dress your needs du­ring the con­ver­sa­tion.

  • We will find the best con­tact person for your in­di­vi­dual needs. Sche­dule 20 mi­nutes for the con­sul­ta­tion.

  • We will in­tro­duce you to the right fer­ti­lity clinic from our net­work, make an ap­point­ment and ac­com­pany you until your wish for a child is ful­filled.

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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