Male infertility: causes, symptoms and treatment

When a couple’s wish to have children goes unfulfilled, attention often turns first to the woman. Yet in many cases, the cause lies wholly or partly with the man, as male infertility is just as common as female infertility. Nevertheless, the subject is rarely discussed – whether out of embarrassment, ignorance or the tacit assumption that fertility is a given. Yet even a simple semen analysis can provide initial clarity, and early diagnosis can make a big difference.

Introduction

When a couple is unable to conceive, attention usually turns first to the woman – to her cycle, her hormones or the quality of her eggs. Medically speaking, this is not justified, as in around one in two couples struggling to conceive, a male fertility factor plays a role, either on its own or in conjunction with female causes.

Despite these figures, male fertility or male infertility is discussed far less frequently than female fertility or infertility. A key factor is shame. For many men, the idea of having reduced fertility is closely linked to their self-image, even though this connection has no medical basis. As a result, they delay seeking medical advice, misinterpret their symptoms or avoid being examined altogether – often only doing so once their desire to have children has remained unfulfilled for a considerable period.

Well-informed education can counteract this pattern; it reduces uncertainty, dispels unfounded beliefs and helps men to take action at an early stage.

What is male infertility?

The WHO defines infertility as the failure to achieve pregnancy despite regular unprotected sexual intercourse over a period of 12 months. From this point onwards, an investigation is recommended, provided there are no known pre-existing conditions or risk factors; otherwise, an earlier assessment may be advisable. This definition initially refers to the couple as a whole and does not yet indicate whether the cause lies with the man, the woman or both.

A male fertility factor is only considered to be present if the man’s examination reveals abnormalities that could impair the likelihood of pregnancy. This may, for example, relate to the count, motility or other characteristics of the sperm, but may also involve hormonal, genetic or anatomical factors. It is important that the man is examined from the outset, rather than only once no clear findings have been identified in the woman. Guidelines expressly recommend that both partners undergo assessment at the same time.

An abnormal result does not automatically mean that a natural pregnancy is ruled out; conversely, a normal result does not guarantee a pregnancy either. Whether a pregnancy occurs depends on many factors on both sides, including the woman’s cycle and fertility, as well as chance.

Are there any symptoms of reduced male fertility?

Most men do not initially notice any signs of reduced fertility, such as pain or other noticeable symptoms. Often, the problem is only recognised when pregnancy does not occur over a prolonged period, despite a desire to have children.

In some cases, however, physical signs may appear, such as changes in the testicular area – for example, swelling or lumps – a reduced sex drive, pain in the genital area, or indications of a hormonal imbalance, such as persistent tiredness or changes in body hair.

These symptoms are not, however, definitive. They can have a wide variety of causes and are not necessarily related to fertility. Self-diagnosis is therefore not advisable. Anyone who notices such changes in themselves should seek medical advice.

How is male fertility assessed?

The assessment usually begins with a consultation with a doctor, during which any pre-existing conditions, medication and risk factors are discussed. This may be followed by a physical examination.

A key part of the process is the semen analysis. For this, the man provides a semen sample, which is then examined in the laboratory. The main factors assessed are sperm concentration (how many sperm are present), motility (how mobile they are) and morphology (their shape), as these factors influence a man’s fertility.

A single abnormal result does not automatically mean that a man is infertile. As results can vary from sample to sample, a semen analysis often needs to be repeated if any abnormalities are found, in order to obtain a reliable overall picture.

Depending on the findings, additional tests may be advisable, such as hormone analyses, ultrasound scans or genetic tests. Which tests are necessary depends on the individual situation.

What are the possible causes of reduced male fertility?

Reduced male fertility can have various causes, such as disorders affecting sperm production, hormonal changes or anatomical problems such as a blockage of the sperm ducts. Certain medical conditions, infections or medical treatments may also play a role.

In addition, lifestyle factors such as smoking, severe obesity or heavy alcohol consumption may play a part, but are not automatically the sole cause. Furthermore, the cause cannot always be clearly identified, even after a thorough examination.

What treatment options are available?

The appropriate treatment depends on the cause and the individual’s circumstances. Options may include surgical procedures, drug therapies or treatment of an underlying condition. Adopting a healthier lifestyle – such as cutting down on smoking and alcohol, or maintaining a healthier body weight – can also have a beneficial effect.

If these measures do not sufficiently improve fertility, or if the cause remains unclear, there are also assisted reproductive techniques such as insemination, IVF or ICSI, which can still make parenthood possible.

Implications for those affected

Reduced fertility has nothing to do with masculinity or sexual performance, but it can nevertheless be a source of psychological distress for many men, particularly when there is a strong desire to have children.

That is why you should not avoid having a test out of embarrassment. A semen analysis is simpler than many people think. It simply involves providing a semen sample, which many providers now allow you to do conveniently from home. The Onuava Shop also stocks a test kit that allows you to check your own sperm quality discreetly and easily; the results are then assessed by an experienced andrologist.

Conclusion

Infertility is not solely a women’s issue; it affects men just as frequently. As reduced fertility often causes no clear symptoms, it is only discovered in many men when they are trying to conceive. The assessment is based on medical history, a physical examination and, as a rule, a semen analysis; the appropriate next steps depend on the individual findings.

Addressing one’s own fertility at an early stage helps to alleviate uncertainties and provide clarity, both for the individual and for the couple’s shared desire to have children. The first step is often an open discussion with a doctor – ideally a urologist, andrologist or fertility clinic.