Infertility in men
Synonyms
Impotence, sterility, infertility
definition
Sterility is usually defined as the inability of a couple to father children if, despite the desire to have children, after at least one year of sexual intercourse without contraception, conception does not occur.
The cause of the unfulfilled desire to have children can lie with both the woman and the man. Infertility is equally common in both sexes. Every sixth married couple in Western European countries is childless and is looking for causes and medical advice.
frequency
It is believed that approx 10 to 15 percent of all marriages are involuntarily childless.
Since the reasons for this can equally be with the woman or the man, both spouses should undergo an examination.
It is estimated that approximately 40 percent of men have decreased infertility. Therefore are also included 40 percent of women the reasons. With the rest 20 percent therefore the problems for men and women are common.
Causes of Infertility in Men
General causes:
The man's sperm capacity and quality are of particular importance when conceiving a child.
The capacity of the semen is already determined shortly after the birth of a boy.
Therefore, a mother's lifestyle during pregnancy also affects her son's fertility.
The consumption of alcohol and nicotine can have a significant negative impact on the child's later sperm production. The consumption of beef during pregnancy is also said to have a fertility-reducing effect. Toxins can affect or even damage the cells that are used to produce sperm.
These so-called Sertoli cells produce the sperm and are also responsible for nourishing the maturing sperm. The fewer there are of them, the fewer sperm cells are ultimately produced.
A reduced semen and sperm quality is the most common cause of infertility in men. One speaks of oligo- astheno-teratozoospermia. This term describes the sperm as not moving normally, not looking normal, and too few in number.
Sperm quality can also be reduced by medication, stress, alcohol and other toxic substances. Another nuisance is caused by the contamination of water and meat with estrogens.
Read more on the topic: Sperm
Other causes can be diseases of the testicles, epididymis, urethra, vas deferens and the prostate.
An undescended testicle occurs when a newborn's testicle is delayed or not moved into the scrotum during development. This malformation should be corrected by the age of 2. In some cases, it can otherwise lead to infertility.
Diseases, in particular inflammation of the epididymis and prostate, can also have an impact on the function of the testicle and cause sterility.
Injuries to the urethra or the vas deferens directly can result from accidents or during an operation and lead to an obstruction or loss of function, which ultimately leads to the inability to conceive.
The prostate in particular plays an important role. Your fluid is very important for the function and mobility of the sperm. Inflammation or other diseases can affect the fluid and thus also have a negative effect on the function of the sperm.
A disturbed transport of the sperm through the vas deferens can also be the cause of an unfulfilled desire for children. On the one hand, injuries to the spermatic duct itself can come into question, for example during an operation due to a hernia.
Inflammation caused by sexually transmitted diseases such as chlamydia can spread to the spermatic duct and damage it.
Read more on the subject at: You can recognize a chlamydial infection in men by these symptoms
Furthermore, other secondary diseases can also lead to an occlusion of the vas deferens. Cystic fibrosis is a genetic metabolic disease that affects glands in particular.
Due to the genetic defect, the glands produce more viscous secretions that then clog the gland outlets.
There are also some studies that assume that varicose veins on the testicles are also associated with increased infertility in men. For more information, we recommend our page on: Varicose veins on the testicles - It's that dangerous!
Also read our topic: Chronic epididymis
mumps
Mumps or rubula is a viral infection that often occurs in children between the ages of five and nine.
But it can also affect older children and adults. A dreaded complication of an infection with the mumps virus is the so-called mumps orchitis, an inflammation of one or even both testicles.
This affects around 20 to 30 percent of those affected. This results in testicular atrophy in half of those affected (Testicular atrophy). Finally, this can also result in decreased fertility.
After the inflammation, half of the patients have abnormal sperm, which also increases the risk that they will not function and decreases the chance of fathering a child. The risk of the sick boy of being completely sterile at a later age increases significantly if the inflammation affects both testicles.
If no clear cause of the infertility can be found in the man or woman, doctors often suspect a psychological problem such as stress or too much pressure that it absolutely must work. Last but not least, men often suffer from it and develop erectile disorders and lose self-confidence.
diagnosis
General diagnostics:
For many couples it is initially a problem to be able to admit that the reason for the childlessness could possibly lie with either partner.
The way to get help and advice is often a burden for both spouses and not just for them relationshipbut also for that own psyche represent.
Hence it is important to get on with the topic knowledgeable doctor to go in whom one has confidence. Since the causes of a infertility can be equally true for both sexes, it makes sense if both partners to get a check up.
First, the doctor becomes one anamnese perform in which he questions about the Habits, the Sexual intercourse, Medication and Diseases represents. This gives him a complete overview and can make an initial assessment of the causes psychological or organic Can be nature.
Then the clinical examinationwhich includes several tests in men.
Genital examination:
The doctor examines them male reproductive organs and pays attention to external or noticeable changes. Changes to the penis as a Curvature or induration and swelling on one Testicles give an initial indication of a malfunction. The examination also includes the digital rectal examination of the prostate.
The testicles and prostate can also be removed using a Ultrasound can be represented more precisely. This gives the doctor the opportunity to do so tissue changes to discover.
The doctor can also provide a Smear from the skin take on the penis to clarify whether an infectious disease is present or has already been through such as one Chlamydia infection.
Examination of the sperm (Semen analysis)
The Semen analysis represents the most important investigation to clarify how fertile the man is. The examination is usually carried out after a Sex break from three to four days.
The patient gives one Sperm sample obtained through masturbation.
Most practices have separate rooms for this, because the sperm should not be older than two hours for a meaningful examination.
The sample is then placed under the microscope viewed and recorded in a semen analysis. The amount the sample that Appearance of the sperm, say whether she's a normal one shape and agility and finally the number of normal sperm cells is determined.
The result is with the Standard values compared. So is considered normal if at least There are 20 million sperm per milliliter of ejaculate. Furthermore, more than 50 percent be normally mobile and at least 20 percent can move forward quickly.
However, since the quality of the sperm can be very different, the examination is usually after one month repeated.
If the two results are present and deviate from the guide values and if the sperm cells are completely absent in the ejaculate, one of the Infertility be spoken. Indeed, fertilization is still possible with abnormal values, but the probability drops very sharply.
Hormone tests:
Investigating the male hormones is done when the semen analysis shows a decreased number of sperm cells. Especially the hormones FSH (Follicle stimulating hormone) and LH (luteinizing hormone) are important to the Production and maturation of the individual sperm.
Their values are therefore determined. Furthermore, the Testosterone levels in the blood because it is crucial for the production of FSH. Hormonal imbalances can usually be treated well. Be like that Testosterone injections administered when the levels of the body's own Testosterone is too low.
therapy
Insemination:
With this method, the A man's sperm processed. The prerequisite for this is that with the man only a slight disturbance fertility and sufficient sperm are still available.
The processed sperm are then introduced into the woman's uterus using a catheter while she is ovulating. The fertilization can still take place on the natural ways respectively.
In Vitro Fertilization:
In doing this, the woman becomes first hormonally stimulatedby regularly getting the needed Hormones splashes. This will make the Ovaries stimulated to produce several fertilizable egg cells at the same time, their maturation by means of Ultrasonic is monitored.
Then mostly between two and five suitable egg cells aspirated with the help of a needle. In Germany no more than three eggs be convicted. In a reagent dish, fertilization then takes place with prepared sperm cells.
After two to three days, the fertilized egg cells again in the uterus convicted. This method of treatment can be used in couples who have severe infertility in both the man and woman.
Intracytoplasmic Sperm Injection:
First the hormonal stimulation of the woman with subsequent suction of the appropriate egg cells. Then several sperm are not brought together with the egg cells here, but a sperm cell is created with a fine needle directly into the egg cell injected. A very expensive and complex method, which is therefore only available at sehr severe disorder is applied.
genetics
Genetic defects can also be the cause of an existing infertility.
Especially defects on that Y chromosome are problematic because on this gene all genetic information for one normal sperm production lie.
So it may well be possible that a father a defect is passed on to his son. How a defect manifests itself depends largely on the severity of the genetic defect. So it may well be possible that either no sperm are produced or a smaller number but a low remaining fertility is possible.
