Male infertility.
Since the 1970s, sperm quality and quantity have declined by more than 50 %. Unlike the decline in female fertility, this decrease is independent of age. At the same time, the average age at first fatherhood is rising rapidly in the Western world. It is therefore not surprising that in around 70 % of couples trying for a baby, a reduced semen result is a factor in their involuntary childlessness.
Causes of male infertility: from hormones to varicocele.
The most common cause of male infertility is impaired sperm production in the testicles. It can have hormonal reasons, be genetic, or be the result of an undescended testicle in childhood, a varicocele (varicose vein on the testicle), infections such as mumps after puberty, or environmental influences. Febrile illnesses, certain medications, anabolic steroids and regular intense heat exposure can also impair sperm production temporarily or permanently.
In addition, there are disorders of sperm transport: the seminal ducts can be blocked after inflammation or a vasectomy – while sperm production itself is often completely intact. Less commonly, erectile or ejaculatory disorders are present. In cases of severely reduced results, we additionally recommend genetic testing in our own genetics laboratory, WIF Genetics, because chromosomal changes or small deletions on the Y chromosome can also affect sperm production.
The semen analysis: clarity in three values.
To assess semen quality, a semen analysis is carried out. It measures three different parameters: sperm count, sperm motility and the number of normally shaped sperm. Each of these parameters can independently contribute to childlessness.
The treatment options at a glance.
Depending on the semen result, there are different treatment options – from gentle support to the targeted selection of individual sperm.
Insemination
With mildly reduced semen results, insemination can "help" the sperm past the cervix, so that they only have to swim through the fallopian tubes to reach the egg.
IVF
With IVF, the sperm is placed together with the egg in a petri dish and spontaneous fertilisation of the egg is awaited. This primarily requires sufficient sperm density and motility.
ICSI
With low density, low motility or a particularly high number of malformed sperm, an ICSI (intracytoplasmic sperm injection) is performed: a sperm is selected on the basis of its motility and appearance and injected directly into the egg.
PICSI & CHIPSI
To imitate natural selection, with PICSI (physiological ICSI) the biologist lets the sperm bind to a hyaluronan membrane – only sperm that bind successfully are used. With CHIPSI, the sperm pass through a microchip; only sperm cells that make it through the chip within a certain time are used. Both methods can be combined, and CHIPSI is also suitable for insemination.
Testicular biopsy (TESE)
If no sperm at all are found in the seminal fluid, or after a vasectomy, testicular tissue is obtained painlessly with a thin needle under brief anaesthesia. If sufficient sperm cells are found, surplus material can be frozen.
Improving sperm quality: lifestyle counts.
Especially in men, a change in lifestyle can contribute to a positive development of the semen result. Reducing – or better still, giving up – smoking can lead to a marked improvement of the semen result in all three categories. A change in eating habits and the intake of trace elements and vitamins can also contribute to an improvement.
Since the formation of new sperm takes around three months, improvements show up after two to three months at the earliest – so patience pays off here. Regular exercise, a normal body weight, little alcohol and avoiding excessive heat, for example from very frequent sauna visits, also have a favourable effect. You can read how to further increase the chances of natural conception in our guide Getting pregnant.
Diagnostics for men: simple, fast, discreet.
The work-up for men is straightforward: it starts with a semen analysis in our own laboratory, evaluated according to the current criteria of the World Health Organization (WHO). In addition, a hormone status, a urological examination and, if needed, genetic analyses can be useful. Because semen results can vary from sample to sample, an abnormal result is usually rechecked after a few weeks before treatment decisions are made.
Once the diagnosis is established, we discuss the right path together – from insemination and IVF to ICSI. Important to know: a reduced semen result is only rarely an insurmountable obstacle today. At the first appointment – ideally as part of a first fertility consultation – we take time for both partners, because trying for a baby is a team effort.
The first step: a semen analysis
The male fertility work-up is simple and fast – you can read everything you need to know on our page Ferticheck Male: the semen analysis. Our causes page provides an overall overview of the reasons for an unfulfilled wish for a child.
Male infertility: your questions.
How do I know as a man whether I am infertile?
Male infertility usually causes no symptoms at all – most men feel completely healthy. Reliable information comes only from a semen analysis: a simple, fast laboratory test that determines the count, motility and shape of the sperm.
How does a semen analysis work?
The semen sample is collected after an abstinence period of around two to seven days – discreetly, in a private room at our institute. Our laboratory evaluates the sample according to the current WHO criteria, and you then discuss the result at your leisure with our medical team.
Can sperm quality improve again?
Yes, in many cases. Since sperm formation takes around three months, quitting smoking, a healthier diet, exercise and avoiding heat can be reflected in a better result after two to three months. An abnormal semen analysis should therefore always be rechecked before treatment decisions are made.
What happens if no sperm at all are found in the ejaculate?
In so-called azoospermia, no sperm cells are found in the ejaculate – but that does not automatically mean that no sperm are being produced. With a testicular biopsy under brief anaesthesia, sperm cells can often be obtained directly from the testicular tissue and then used for an ICSI.
Which treatment helps with a severely reduced semen result?
With severely reduced results, ICSI is the method of choice: a single, carefully selected sperm is injected directly into the egg. With techniques such as PICSI and CHIPSI, the selection of the best sperm can be refined even further.
Does the man's age play a role?
Semen quality also changes with age in men, but much more slowly and less markedly than female fertility. In principle, men can father children into old age – nevertheless, if the wish for a child remains unfulfilled for a longer time, an early work-up of both partners is worthwhile.
Can the causes be genetic?
Yes. Chromosomal changes or small deletions on the Y chromosome can severely impair sperm production. In cases of pronounced findings, we therefore recommend genetic testing in our own genetics laboratory – the results feed directly into your treatment planning.
We fulfil your wish for a child!
Today there is a suitable treatment for almost every semen result – we will find the right one for you.
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