The other half of the equation

The causes of impaired fertility in men are diverse. Various pre-existing conditions, often occurring in childhood, infections, inflammation of the testicles and epididymis, bladder, or prostate can lead to male infertility.

Cryptorchidism: In childhood, the testicles do not descend into the scrotum but remain in the abdominal or inguinal area. If cryptorchidism is not corrected in time, it can permanently damage sperm production.

Infections: A mumps infection (mumps orchitis) during childhood can lead to testicular inflammation and hardening, resulting in significantly impaired sperm production.

Varicocele: The spermatic cords in the testicles are surrounded by a network of veins. When this network expands, it is referred to as a varicocele. It often affects the left side of the testicle since blood drainage is poorer on that side. The excessive heat generated due to the backflow of blood in the testicular area can affect fertility.

Hormonal Disorders: Hormonal imbalances in men can also lead to infertility. Hormones such as testosterone, FSH, and LH are crucial for sperm production. A deficiency in these hormones can limit male fertility.

Genetic Defects: Genetic diseases, including Klinefelter syndrome with reduced secretion of male hormones and reduced quality of sperm, as well as deletion, the loss of information on the Y chromosome responsible for male sexual characteristics, can lead to infertility. Genetic defects can be identified through a blood test.

Risk factors also include stress, dietary habits, obesity, the use of certain medications, as well as alcohol and tobacco consumption, and environmental factors.In childhood, the testicles do not descend into the scrotum but remain in the abdominal or inguinal area. If cryptorchidism is not corrected in time, it can permanently damage sperm production.

In the case of difficulties in trying to conceive, women are often examined first and only later men are examined. However, a timely examination in men is also necessary.

The diagnosis of fertility disorders in men is performed by a specialist in the field of reproductive health, known as an andrologist. Andrology is a specialized branch of urology. The following examinations and assessments provide insight into male fertility:

1. Comprehensive medical history including previous illnesses and living conditions.
2. Physical examination of the reproductive organs.
3. Ultrasound examination of the testicles.
4. Hormone diagnostics (FSH, LH, prolactin & testosterone).
5. Semen analysis to assess the quality and quantity of sperm cells.
6. Possibly, a testicular biopsy.

Hormone diagnostics

A hormone analysis can be relevant in understanding the causes of unfulfilled fertility desires, especially in cases of reduced sperm quality. Symptoms such as fatigue, loss of vitality, weight gain, and reduced performance may indicate a hormonal imbalance. A hormone analysis can be conducted through a blood test.

The Semen Analysis
The most important diagnostic tool for assessing male fertility is the semen analysis. It involves a microscopic examination of the ejaculate, providing information on sperm quality, sperm count, and sperm density. It also determines the volume of seminal fluid and the pH level of the ejaculate. The ejaculate should be collected through masturbation after a period of abstinence (usually 2-7 days). It must be obtained under sterile conditions, ideally at a local laboratory, or within 30-60 minutes of collection.

It is recommended to perform at least two semen analyses within a period of four to twelve weeks, as both sperm count and quality can fluctuate significantly.

Parameters of Sperm Quality
Sperm must be capable of reaching the egg. Several parameters are crucial for this:

1. Sperm Count: The quantity of sperm has diagnostic significance and provides information about sperm production. Additionally, it indicates the number of sperm transferred during intercourse.
2. Sperm Morphology: Sperm appearance is assessed based on the head, midsection, and tail. In reality, most sperm are not normally shaped and may have multiple heads or tails. According to WHO guidelines, when 4% or more of sperm have normal morphology, it meets the norm.
3. Sperm Motility: Motility is a critical factor for progressing through the female reproductive tract. Sperm must reach the egg, so targeted forward movement is important.

WHO Criteria for a Semen Analysis
The World Health Organization (WHO) has defined criteria for semen analysis, serving as fundamental reference values for assessing sperm quality. These criteria were updated in 2021.

 Ejaculate volume ≥1.4 ml

 Sperm concentration: ≥16 million/ml

 Total sperm count in the ejaculate ≥39 million

 Progressive motility (moving forward
Sperm): ≥30%

 Total motility (progressive & non-progressive) ≥42%

 Morphology (normally shaped sperm): ≥4%

If a result is outside the normal range, treatment may required. Talk to your specialist about the next steps.

DNA fragmentation

The role of a sperm is to safely deliver the father's genetic information to the egg, allowing for the creation of a healthy embryo. However, a DNA break, which is damaged genetic material in the sperm, can prevent the development of new cells and, consequently, an embryo. Even though a sperm analysis may show no abnormalities, fertility can still be compromised. A sperm analysis does not provide information about potential breaks in the DNA strand of the sperm. Various testing methods (such as the TUNEL test or SCD test) allow for the analysis of the genetic material in sperm using a semen sample. Currently, there are no standardized guidelines, but 15-20% of slightly to moderately fragmented sperm can lead to reduced fertility.

If DNA fragmentation is detected, lifestyle adjustments are recommended.