Hypogonadism is an underactivity of the gonads, which in men can take the form of posttesticular hypogonadism, for example. The cause of this fertility disorder is either sperm duct obstruction or other sperm motility impairment. If motility cannot be restored, artificial insemination is performed.
What is posttesticular hypogonadism?
There are different reasons for infertility and inability to conceive, infertility or sterility. Fertility disorders affect women more often than men. In the male, the most common reasons for infertility are abnormal sperm count or motility. Although it is more often the woman who is responsible for a childless marriage, male infertility is also a relatively common phenomenon. Up to 15 percent of marriages remain childless because of male infertility. Posttesticular hypogonadism is a male fertility disorder associated with lack of motility or obstruction of the seminal ducts. The seminal ducts are used to transport seminal fluid and are located within the testes as well as outside the testis. Posttesticular hypogonadism is responsible for male infertility in 20 percent of all cases. Unilateral posttesticular hypogonadism should be distinguished from bilateral posttesticular hypogonadism. Only the bilateral form actually causes male infertility.
Causes
Two variants of posttesticular hypogonadism exist. While one has its cause in the seminal ducts, the cause of the other is in sperm motility or composition. Hypogonadism is basically understood as an underfunction of the gonads. This hypofunction, in addition to the primary form, may be secondary to obstruction of the seminal ducts because the obstruction damages the testis. If the cause is in the seminal ducts, there is a congenital or acquired obstruction of the draining ducts. In the congenital form, aplasia or atresia in the ductus deferens or in the epididymal ducts is usually responsible for the phenomenon. The acquired variant may be associated with inflammation or vascular ligation after hernia surgery. If motility disorders are responsible for infertility, these disorders may be due to different causes. For example, sperm structure disorder may cause sperm immobility. The same is true for improper sperm composition, as may occur in the setting of inflammation.
Symptoms, complaints and signs
Men with posttesticular hypogonadism present with a cause-dependent clinical picture. Usually, the most common symptom is childlessness. In most cases, affected individuals seek medical attention only after their desire to have children remains unfulfilled, despite regular attempts, even after months or years. All other symptoms of posttesticular hypogonadism are not identifiable for the man and are only revealed in the clinical analysis of the spermiogram. For example, posttesticular hypogonadism may be characterized by a lack of spermatozoa in the male ejaculate when there is an obstruction of the seminal ducts. This symptom is also known as aspermia. Other developmental stages of semen may also become deficient if there is an obstruction. On the other hand, if a motility disorder is present, the spermiogram will show structurally and mobility restricted spermatozoa. Depending on the primary cause, accompanying symptoms such as pain may be present. This is the case, for example, with causative inflammation, which may be responsible for the lack of sperm motility.
Diagnosis and course of the disease
The diagnosis of posttesticular hypogonadism is made by a fertility doctor. Usually, affected individuals with a long-term unfulfilled desire to have children go to a fertility clinic, where a spermiogram is obtained. The spermiogram is obtained in the laboratory, and the main purpose of the diagnosis is to determine the form of posttesticular hypogonadism. If there is evidence of no spermatozoa in the sample, there is an obstruction of the spermatic ducts. If spermatozoa are present but not sufficiently motile, it is the second variant of the disease. The prognosis depends on the type of posttesticular hypogonadism.
Complications
In most cases, this condition results in infertility in the patient. This need not be fully developed, but can lead to an unfulfilled desire to have children. In this case, however, the affected person can usually resort to other methods to still pursue the desire to have a child. Furthermore, this disease can lead to severe psychological complaints or even depression. The affected person suffers from a significantly reduced self-esteem or also from inferiority complexes. The patient’s quality of life is also considerably restricted and reduced in this disease. In many cases, those affected are ashamed of the symptoms of this disease, so that a doctor is not consulted directly. In some cases, the disease also causes mild pain in the testicles, which can lead to general irritability. However, other health restrictions do not occur. Treatment of this disease is usually not possible. Nevertheless, a desire to have children can be pursued with the help of various techniques. As a rule, no particular complications occur. The life expectancy of the patient is also not affected.
When should you go to the doctor?
If infertility is suspected, the physician should be consulted. Posttesticular hypogonadism is generally manifested by a lack of sperm cells in the male ejaculate. Therefore, men who do not desire to have children do not necessarily need to seek medical advice. However, if the underlying testosterone deficiency causes further symptoms, it is best to consult a doctor. Men over the age of 30 are particularly at risk. Men suffering from pre-existing conditions of the endocrine system are also at risk and should consult a professional if signs of post-testicular hypogonadism occur. The family doctor or a urologist can be consulted. If a psychological problem underlies the complaints, the physician will establish contact with an appropriate psychologist or sex therapist. If necessary, couples therapy is also possible if the hypogonadism is associated with an unfulfilled desire for children in the partnership. Often the syndrome progresses without clear symptoms and the testosterone level regulates itself over the years.
Treatment and therapy
The treatment of fertility disorders is a rather young therapeutic area. In many cases of hypogonadism, substitution therapy with sex hormones already leads to the desired success. In men, this substitution corresponds to the administration of androgens. Testosterone, DHEA and anabolic steroids can be considered as active substances from the group of sex hormones. In the case of obstruction of the vas deferens, causal therapy is usually also considered, in which the obstruction of the vas deferens is surgically dissolved. However, this procedure often does not restore the original testicular function. The testicles have usually already suffered irreversible damage as a result of the obstruction. If hormone substitution does not lead to the desired result either, the motility of the sperm must be improved. Zinc, for example, can be beneficial in this regard. In most cases, however, artificial insemination is required if motility remains impaired. For this purpose, eggs are removed from the woman and brought into contact with the man’s sperm “in a jar”. Often the sperm are injected directly into the egg. This direct injection increases the likelihood that fertilization will be successful despite motility restriction. The fertilized egg is reinserted into the woman, and ideally she carries the child to term.
Prevention
Prevention measures for pottesticular hypogonadism include, first and foremost, a healthy and balanced diet. In particular, an adequate supply of zinc contributes to sperm and gonad health. Fertility disorders caused by occlusion can be prevented by regular examination of the seminal ducts. If an occlusion that has occurred is noticed and resolved in time, fertility is usually maintained without restriction.
Follow-up
Men who suffer from posttesticular hypogonadism can pay attention to a health-conscious diet as part of their follow-up care. Often, the treating physician recommends taking zinc.Increased intake of zinc improves sperm motility and health, and the seminal ducts become clear again. A vitamin-rich diet with sufficient zinc is therefore very helpful. For aftercare as well as for prevention, the recommendations of the medical profession go in the same direction. In addition, a regular examination of the seminal ducts should take place after an initial illness. Patients can initiate this check-up themselves so that fertility is not impaired. If the therapy has not been successful, those affected must come to terms with their inability to conceive. Here it is useful to ward off negative feelings such as shame and inferiority complexes by being open. In the relationship with the partner, patients should be honest and not simply ignore the topic. Otherwise, it can even lead to depression or a separation from the partner. Those who consciously accept the consequences of the disease often have other options open to them. Affected men can also talk to their partner about artificial insemination, adoption or foster parenthood.
What you can do yourself
This diagnosis falls in the vast majority of cases at the fertility doctor, because patients with posttesticular hypogonadism often have no other complaints. The first indication of the disease is involuntary childlessness. If Posttesticular Hypogonadism is caused by an infection, it can be treated medically. Surgical interventions and/or hormone substitutions may also lead to the spermatic ducts becoming clear again and the sperm becoming mobile. Some doctors also recommend taking zinc to increase sperm motility. Even a healthy diet rich in vitamins can help to naturally reduce the blockage of the seminal ducts. However, patients often have to come to terms with their inability to conceive and may have to find other ways to become a father. This can be artificial insemination but also adoption or taking in a foster child. The Federal Ministry for Family Affairs, Senior Citizens, Women and Youth has set up an information portal for this purpose (www.informationsportal-kinderwunsch.de), which, among other things, provides information about counseling centers in the vicinity of those affected. The “Wunschkind” association (www.wunschkind.de) also provides independent information and coordinates self-help groups. Talking openly with one’s partner and other affected persons can prevent feelings of shame or inferiority, which could otherwise often lead to self-reproach, depression and, not least, separation.
