Brief overview
- Description: Infertility in a man occurs when he is unable to father a child within one year despite regular, unprotected sex.
- Symptoms: Signs are usually nonspecific and range from weight gain to swelling of the testicles to pain when urinating.
- Causes: Common causes are sperm production disorders, impaired sperm quality, diseases, injuries to the testicles, congenital malformations.
- Treatment: e.g. hormone treatment, artificial insemination (e.g. intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI)), surgery, healthy lifestyle.
- Diagnosis: including discussion with the doctor, physical examination, spermiogram, ultrasound of the testicles, hormone tests.
When is a man infertile?
How many men are infertile?
According to estimates by the World Health Organization (WHO), around 186 million people worldwide are considered infertile. If a couple cannot have children, in about one-third of cases it is due to male infertility. Research also shows that male infertility is on the rise in Western industrialized nations.
Signs of male infertility
Except for symptoms associated with functional sexual or erectile dysfunction (e.g., when a man cannot get an erection), male infertility usually does not manifest itself physically. However, the first signs of developing infertility in men may be weight gain or loss and swelling of the testicles. A discharge from the penis or pain during urination or in the testicles also indicate an infection, which may also lead to infertility in men.
Causes of infertility in men
There are many causes of infertility. The following reasons may be behind infertility in men:
Low sperm quantity and poor sperm quality.
Sometimes, however, there are too few sperm in the ejaculate (oligozoospermia) – either because the production or transport of sperm does not function optimally. It may also be that too few sperm are motile (asthenozoospermia) or too many sperm are malformed (teratozoospermia). In some infertile men, all three problems occur at the same time. This is when doctors refer to it as OAT syndrome (oligo astheno teratozoospermia).
In 30 to 40 percent of cases, doctors find no reason for infertility in men (called idiopathic male infertility).
Genetic reasons
But even if there are enough sperm and they appear fit and fast at first glance, the man can be infertile – namely, if, for example, an altered gene prevents the sperm from making it through the uterine mucus. A change in the chromosomes in a man can also cause the testes not to produce sperm (e.g. Klinefelter’s syndrome: when a man has two X chromosomes and produces too little testosterone).
Age of the man
Damaged testicles
Only intact testicular tissue produces fertile sperm. Numerous factors, sometimes present at birth or in infancy, can damage the testes and limit sperm production and thus male fertility in adulthood:
- testicular inflammation 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 underactivity of the testicles (hypogonadism), which usually also results in reduced libido
- Genetic anomalies (e.g. Klinefelter syndrome: when a man has two X chromosomes and produces 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 also suffer damage. If the temperature in the testicles rises above 32 degrees Celsius due to varicose veins (varicocele), circulatory disorders, undescended testicles, special sports or workplace conditions, the sperm quantity decreases.
You can read more about this in our article Infertility.
Damaged vas deferens
Sometimes a blocked or severed vas deferens prevents sperm from arriving (obstructive azoospermia). Reasons for this form of male infertility include:
- infections (e.g. chlamydia)
- Inflammation of the testicles, epididymis (orchitis, epididymitis) and prostate (prostatitis)
- Narrowing of the urethra
- Surgery (e.g. for a hernia)
- cystic fibrosis (cystic fibrosis)
- congenital malformation
Other reasons for infertility in men include:
- defective closure of the urinary bladder (retrograde ejaculation), so that ejaculation ends up in the bladder (in the urine). Possible causes: surgery, diabetes, nerve damage, enlarged prostate.
- Immunologic sterility: the body makes antibodies against its own sperm.
- Hormonal changes: Testosterone deficiency, disorders affecting thyroid or pituitary gland hormones (e.g., hyperthyroidism or hypothyroidism).
- Taking anabolic steroids (bodybuilding)
- Taking certain medications (e.g. immune system suppressing drugs, anti-depression drugs, anti-hypertensive drugs).
- Erectile dysfunction (impotence)
The reason for infertility can also be with the female partner or both together. For this reason, it is important that both the woman and the man get tested for possible infertility.
You can find out more about this topic in our article Infertility in women.
Infertility in men: treatment
If it does not work with the conception immediately, you should first check your lifestyle habits: A healthy diet, exercise, abstaining from nicotine and alcohol, and stress reduction can improve sperm quantity and quality.
The right amount of sex is also important: sexual intercourse every three days seems to be recommended for procreation problems. Daily sex, on the other hand, does not increase the chances of success, but rather reduces the sperm count in the ejaculate.
If the doctor has found a physical cause, treatment is based on this. It should be carried out after thorough consultation with an experienced urologist/andrologist or at specialized fertility centers. The following treatment options are available:
- psychotherapeutic treatment
- Surgery for varicose veins on the testicle or obstructed spermatic duct
- drug treatment for hormone deficiency or erectile dysfunction
- Vacuum pump
- Penile implant
If these measures do not help, other therapeutic measures are available:
Sperm extraction
If the sperm are fertile and just cannot find their way out, a testicular sperm extraction (TESE) may be useful. This involves sperm extraction from the testicular tissue by means of a testicular biopsy.
New techniques for identifying mature sperm (PICSI, “physiological intracytoplasmic sperm injection”) or sorting out less suitable sperm (IMSI, intracytoplasmic morphologically selected sperm injection) promise better chances of success in infertility. In this way, a couple can often be helped to have the offspring they have longed for.
Artificial insemination
With the sperm selected in this way, the doctor can use artificial insemination techniques (assisted reproductive technology, ART) to fulfill the desire for a child:
- Intrauterine insemination (IUI): transfer of sperm into the uterus.
- In vitro fertilization (IVF): test tube fertilization.
- Artificial insemination by sperm donation
Infertility of the man: Joint way
The diagnosis of infertility puts a strain on the couple relationship. Whoever the trigger is for the infertility – the couple should be united in the decision for infertility treatment and want to take this path together. Understanding, patience and open discussions are especially important during this time. Professional psychological support can increase the success of treatment for male infertility.
Male infertility: Diagnosis
In the case of male infertility, the urologist or andrologist is the first point of contact. First, the doctor conducts a detailed interview with the patient (e.g. about previous diseases, infections, operations, cycle disorders, miscarriages, abortions, life circumstances, partner relationship. This is followed by several examinations:
- Examination of the genital organs
- Assessment of hair/body structure
- Ultrasound of the testicle
- Ejaculate examination (spermiogram)
- Hormone level measurements (via blood test)
- Testicular biopsy
- if necessary genetic examination by blood test
