Infertility in Men : causes, Symptoms And Solution

 

In the case of involuntary childlessness, going to the doctor is often harder for men than for women. Because fertility is often equated with "masculinity".

 

In order to fulfill the desire for a family, however, men should jump over their shadow and contact an andrologist or a urologist who specializes in the field of male fertility diagnostics. Because an unfulfilled desire to have children always affects the couple as a unit and not the individual partner. Experts estimate that in about 50% of the cases when a couple remains childless, there are combined problems on both sides. That is why diagnostics are not only important for women, but also for men!

 

 

Consultation with the doctor (anamnesis)

 

In the case of involuntary childlessness, the focus is primarily on a confidential discussion with the urologist. The previous medical history and family planning as well as possible sexual problems are discussed. The expert will also talk to men about social factors and environmental influences (e.g. stress, smoking, alcohol consumption).

The fertility-disturbing influences include, for example

• undescended testicles,
• inflammation of the genital and pelvic organs,
• injuries and surgeries and
• General diseases such as high blood pressure or diabetes.

If there are indications of one of these clinical pictures during the conversation, the doctor will arrange for appropriate examinations. Past or ongoing drug treatments that can affect the man’s hormone cycle are also asked about. Last but not least, the doctor will also address an unusual course of physical development during puberty and hereditary diseases in the family.

 

Physical exams     

 

The interrogation is followed by a general physical examination. The medical standard includes recording body height and body weight and using this to determine the BMI since both underweight and overweight are possible causes of fertility problems. The doctor also scans the testicles, epididymis, and vas deferens. If necessary, the doctor will also examine the testicles, prostate, and urinary tract using ultrasound.

 

Spermiogram

 

The most important point of the clarification is the spermiogram: With the result of the spermiogram, the first course is set in the fertility treatment and the question is answered as to whether a normal pregnancy is possible at all. It is a simple examination, which should therefore be right at the beginning of the fertility assessment. As long as no spermiogram is available, no woman should be expected to undergo a complex clarification.

• Sperm analysis: The man's sperm is examined for fertility. The seed is examined under a microscope.

 

• Fertility test: In the fertility test of the semen in the laboratory, the number of sperm per milliliter or the total number of sperm in the semen is first determined (concentration).

A spermiogram is considered normal if:

• there are more than 15 million sperm per ml,
• of which more than 32% move forward and
• at least 4% of the sperm are normally formed,
• the amount of liquid per ejaculation should be more than 1.5 ml
• In addition, the vitality of the sperm, the consistency, the pH value, and the presence of bacteria are assessed.

In order to achieve particularly meaningful results, the man should not have ejaculated for 2 - 7 days before this semen test.

The man wins the semen sample mostly through self-satisfaction (masturbation). In specialized practices, a "donation room" is usually available for sperm collection. If this irritates the man, the sperm can also be collected at home after consultation with the doctor. Regardless of how the ejaculate is obtained, it must be transported to the examination in a special container that the man receives from the doctor.

Since the quality of the sperm can vary, a spermiogram is usually carried out 2 to 3 times in order to get a definitive assessment of the man's sperm quality. After the examination, the doctor will discuss all of the values determined by the spermiogram in detail with the man – preferably accompanied by his partner.

Seed home tests

There are now also home tests that can be used to assess the quality of the sperm cells. It is important to ensure that self-tests are chosen that not only determine the number of sperm (regardless of whether they are motile or immobile) in the ejaculate. Instead, new, patented tests are used to measure the concentration of motile sperm, which has a significant impact on the probability of fertilization of the female egg cell.

 

Ultrasonic

 

In addition to the spermiogram, which should always be carried out as part of a urological examination, it is also important to examine the testicles with ultrasound. The testicular volume can B. be reduced due to a hormone imbalance, a developmental disorder, or a previous testicular inflammation.

 

In addition, the vascular system of the testicles can be examined by ultrasound and a varicose vein (varicocele) can be identified. A varicocele can contribute to a disturbance in fertility, but it can be treated well.

The doctor will also take a close look at the tissue structures of the testicles and the epididymis using ultrasound. Testicular tumors can - albeit very rarely - be the cause of fertility disorders.

The overall assessment of the situation takes place in a detailed confidential discussion.

Possible causes for suboptimal spermiograms are:

• Undescended testicles or pendulum testicles
• existing or past inflammation
• General diseases such as high blood pressure or diabetes
• Lifestyle factors, especially smoking

If there are very few sperm in the semen, then a hormone analysis and a genetic test should definitely be carried out.

 

Hormone analysis       

 

If there are only very few fertilizable sperm in the semen, the man is usually advised to have a hormone analysis to clarify whether the hormonal control of the testicle function is disturbed. The hormone status is determined by taking a blood sample.

The functions of the testicles – ergo also the production of sperm cells – are dependent on the formation and release of certain hormones. These include:

• The follicle-stimulating hormone (FSH): It is produced in the pituitary gland and controls the development and function of the male gonads (testes) and the formation and maturation of sperm cells.

 

• Testosterone: It is the main male sex hormone. It is formed directly in the testicles and is therefore an expression of good testicular function.

 

 

• Luteinizing hormone (LH): This hormone contributes to sperm maturation in men and is therefore included in a hormone analysis as standard.

 

• The hormone prolactin: An imbalance can indicate a disease of the pituitary gland, which can disrupt the formation of FSH, testosterone, or LH and thus also impair testicular function.

 

Hormone treatment in men

 

Hormone treatment for men with unwanted childlessness leads to a normalization of the testicle function in over 80% of those affected. In the case of an FSH/LH deficiency, the administration of missing hormones makes sense. Hypothyroidism or hyperprolactinemia (increased concentration of prolactin in the blood) must also be treated. However, testosterone administration in the case of a testosterone deficiency cannot improve fertility.

If the sperm count is very low, it can be checked whether genetic abnormalities are responsible for the problem. For this purpose, a blood sample is cultivated in the laboratory and is examined for genetic disorders. These tests are particularly useful for men with fewer than 10 million sperm per milliliter of ejaculate.

 

Genetic fertility tests

                                                                                                             

The karyogram (chromosome analysis)

It is the "simplest" genetic examination, with the help of which mainly chromosome breaks or chromosome translocations are revealed. A bad spermiogram alone is not an indication of chromosomal breaks. However, the karyogram is required by some geneticists for all couples wishing to have children, male and female (in the normal population, these breaks occur in 1%; in couples wishing to have children, they are twice as common at 2%). If there are chromosomal breaks, the chance of becoming pregnant is significantly reduced, and the risk of an early miscarriage is usually increased. The risk of genetic malformation syndromes can also be increased.

A rare, special karyogram finding in extremely bad spermiograms is the so-called Klinefelter syndrome (in principle healthy men have an additional X chromosome).

Molecular genetics investigations

In the case of extremely poor spermiogram results (azoospermia): If no sperm are present, a special form of cystic fibrosis can rarely be the cause. Therefore, in men with azoospermia, genetic testing for cystic fibrosis is mandatory. If this finding is positive, the partner must also be examined. If the partner is also a carrier of a cystic fibrosis gene, the risk for the planned child must be discussed in genetic counseling. A risk for the child can be ruled out or minimized as part of pre-implantation diagnostics, which would be permitted in these cases.

A so-called azoospermia gene is rarely present in otherwise healthy men. The chance of pregnancy is then extremely low. Male offspring are then also carriers of the gene - one can say that infertility is thus passed on.

 

Testicular biopsy

 

During this examination, a tissue sample (biopsy) is taken from the testicles. If there are few or no sperm cells in the ejaculate, this can be used to determine whether the testicles are always producing sperm. If this is the case, the sperm cells obtained with the testicular biopsy can be deep-frozen (cryopreservation) so that any artificial insemination can be carried out later. The testicular biopsy is therefore both part of the diagnosis and the treatment of a fertility disorder.