In two thirds of cases, the man’s reduced fertility is part of the reason a woman is unable to get pregnant. There are simple, low-stress examinations to help identify and treat many of the causes.
Exactly one percent of the male population is actually infertile. The ejaculate of these men contains no sperm. In all other cases, fertility is slightly to greatly reduced. In many cases, however, lower male fertility can be compensated by good female fertility and vice versa.
Examination procedure
At the beginning of the consultation, the man answers questions about his health status. The goal is to identify potential risk factors. Next, he undergoes a physical examination with a testicular and epididymal ultrasonography. The examination is completed with a blood test to measure hormone levels and a spermiogram (see info box). All of this is completely painless and non-invasive.
Varicoceles: the most common cause
Varicoceles are the most common reason for reduced fertility in men. The veins along the spermatic cord and epididymis become enlarged, which can lead to a rise in temperature and pressure in the testes. This has a negative effect on sperm quality. Surgical removal or sclerotherapy can be used to treat the affected veins along the spermatic cord.
Other potential causes of infertility:
- Hormonal disorders
- Growths or tumours
- Congenital disorders
- Past occurrences, such as testicular infections
General methods of examination
The spermiogram is an important screening method for testing male fertility. The main purpose of the examination is to determine sperm quality. A spermiogram is conducted in the laboratory in order to determine the composition and motility of the sperm cells and the sperm count in the ejaculated male semen, by testing the following properties:
- pH value
- Sperm count
- Sperm motility (mobility)
- Sperm vitality
- Sperm morphology
Methods of treatment
- Artificial insemination: The semen is processed in the doctor’s surgery in order to filter out the motile and normally formed sperm. These are introduced directly into the womb at the time of ovulation using a thin catheter.
- In vitro fertilisation (IVF): With this form of treatment, fertilisation takes place outside of the womb: egg and sperm cell are brought together in a test tube and returned to the womb using a thin catheter after fertilisation (embryo transfer).
- Intra-cytoplasmic sperm injection (ICSI): ICSI is a further development of in vitro fertilisation. In cases where the man has severely impaired fertility, a single sperm is inserted directly into the egg cell.
- Microsurgical epididymal sperm aspiration (MESA)/Testicular sperm extraction (TESE): MESA involves retrieving sperm from the epididymis. In the case of TESE, a tissue sample is taken from the testicles. Either method can be combined with ICSI.