What does male infertility mean?
If pregnancy does not occur despite regular unprotected intercourse, the causes can lie with the woman, the man, or both partners. In about one-third of couples with an unfulfilled desire to conceive, a male factor plays a significant role.
Unintended childlessness is generally referred to when no pregnancy has occurred after twelve months. However, depending on the partner’s age, medical history, or existing risk factors, an evaluation may be advisable earlier. For men, the focus is primarily on sperm production and sperm quality.
Are there signs of impaired fertility?
Impaired male fertility often causes no noticeable symptoms. However, certain changes or complaints can indicate conditions that may also affect fertility. These include, for example:
- palpable varicose veins in the testicle (varicocele)
- pain or swelling in the testicular area
- discomfort during urination
- erectile or ejaculation disorders
Since impaired sperm quality is usually not externally recognizable, male fertility can only be reliably assessed through an appropriate medical examination.
When is a medical evaluation advisable?
An examination of male fertility is particularly advisable if:
- no pregnancy has occurred for about twelve months despite regular unprotected intercourse
- the partner is over 35 years old and no pregnancy has occurred for about six months
- known pre-existing conditions or risk factors exist, such as undescended testicles, testicular diseases, or surgeries
- chemotherapy or radiation therapy has been performed
- testicular abnormalities, erectile dysfunction, or ejaculation disorders are already known
- fertility treatments have repeatedly not led to the desired success
In the presence of known risk factors, an examination may also be advisable regardless of the previous duration of the desire to conceive.
Causes of Male Infertility
The causes of impaired male fertility are diverse and not always clearly assignable. Organic, hormonal, or genetic factors can play a role, as can certain diseases, environmental, and lifestyle factors. A medical evaluation can help identify possible and, in particular, treatable causes.
Various diseases or physical changes can impair the formation, maturation, or transport of sperm. These include, among others:
- undescended testicle in childhood, even after surgical correction
- inflammation or infections of the testicles and epididymis, for example, after a mumps infection in childhood
- varicose veins in the testicle (varicocele), which may be associated with impaired sperm quality
- injuries or surgeries in the area of the testicles or efferent seminal ducts
- erectile or ejaculation disorders
- retrograde ejaculation, where ejaculate partially or completely enters the bladder
- previous chemo- or radiation therapies that can temporarily or permanently impair sperm production
Hormonal disorders can also affect sperm production. These include, for example, disorders of hormonal regulation by the hypothalamus or pituitary gland, as well as testosterone deficiency. Depending on the findings, further hormone diagnostics may therefore be advisable.
Genetic changes can impair sperm formation, maturation, or transport. These include, for example:
- Klinefelter syndrome, where an extra X chromosome is present
- AZF deletions on the Y chromosome, which can impair sperm production
- CFTR mutations, as can occur in cystic fibrosis, can lead to, among other things, the absence or incomplete development of the vas deferens in men
Genetic evaluation may be particularly useful in cases of severely reduced sperm count or when no sperm are detectable in the ejaculate.
3. Age and Sperm Quality
Age affects male fertility less significantly than female fertility. Nevertheless, various sperm characteristics can change with increasing age. Among other things, motility and DNA integrity can decrease. Certain genetic changes in sperm also occur more frequently with increasing paternal age.
4. Environmental and Lifestyle Factors
Lifestyle and environmental factors can also influence male fertility. Possible factors include, among others:
- smoking, which can negatively affect sperm count, motility, and DNA quality
- high alcohol consumption and drugs
- overweight or underweight
- frequent or prolonged heat exposure in the testicular area, for example, due to very hot baths, frequent sauna visits, or other forms of regular overheating
- testosterone and anabolics, which can suppress the body’s own hormone regulation and thereby significantly reduce or even temporarily completely halt sperm production
Environmental chemicals such as endocrine disruptors are also being investigated as possible influencing factors on male fertility. These include, for example, BPA and phthalates.
Procedure for Male Fertility Examination
At the private center Die Kinderwunschärztin in Munich, we accompany you step by step – individually, transparently, and with the utmost care.
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Select & Start Test
You choose the appropriate fertility test – either for home use or for performance at our private center in Munich – and then answer a few short questions online about your situation.
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Sample Collection
The semen sample can be collected discreetly in our men’s room or at home. For home collection, we will provide you with a suitable container in advance. Before sample collection, please observe the instructions regarding the recommended abstinence period in your appointment confirmation. Bring the sample to our fertility center, transported close to the body, within a maximum of 40 minutes after collection, at the agreed appointment.
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Analysis & Results
The sample is analyzed immediately in our in-house andrology laboratory. You will usually receive the medically reviewed findings encrypted by email within less than three working days.
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Further Procedure
Should the results be outside the normal range, we recommend repeating the spermiogram after a few weeks to verify the results and enable a reliable assessment. Based on this, we will decide together with you which next steps are appropriate.
Overview of Male Fertility Diagnostics
Various examinations are available for the evaluation of male fertility. The basis is the spermiogram, which assesses, among other things, the number, motility, and morphology of sperm.
Depending on the findings, medical history, and previous course of the desire to conceive, further examinations may be useful. They allow a more precise investigation of certain properties and functions of sperm that are not covered in a classical spermiogram.
The spermiogram is the most important basic examination for assessing male fertility. It analyzes, among other things, the number, motility, and morphology of sperm according to current WHO criteria. The examination is carried out directly in our andrology laboratory and evaluated by a medical doctor.
An unremarkable spermiogram does not exclude impaired fertility in all cases, as damage or breaks in sperm DNA are not detected by classical ejaculate analysis. Therefore, a DNA fragmentation test may be useful in cases of repeated unsuccessful fertility treatments, recurrent miscarriages, or unexplained male infertility. This test examines the proportion of sperm with genetic damage. This allows for a more detailed assessment of sperm quality and can provide additional clues for further treatment.
A spermiogram assesses the number, motility, and morphology of sperm, but not their functional maturity. The HBA test (Hyaluronan Binding Assay) examines how many mature sperm can bind to hyaluronic acid – an ability that plays an important role in the natural fertilization of the egg. Thus, the test can provide additional information on the functional quality of sperm.
Even with an unremarkable spermiogram, sperm may not be functionally capable of fertilizing an egg. A possible cause is a disorder of the CatSper channel, which is crucial for the so-called hyperactivation of sperm and thus for penetration into the egg. This disorder is not recognizable in a normal spermiogram and is estimated to be found in about 2% of men with unexplained infertility.
In the event of a complete loss of CatSper channel function, natural fertilization is not possible. The CatSper test can therefore provide important clues for choosing the appropriate treatment, especially in cases of unexplained desire to conceive or repeatedly failed fertilization.
In cases of abnormal findings or unclear causes, a supplementary andrological evaluation may be advisable.
Depending on the specific question, this includes a detailed medical history, physical examination, hormone analyses, and ultrasound examinations of the testicles and epididymis.
We specifically recommend a referral to andrology if the previous diagnostics provide corresponding indications.
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Comprehensive Sperm Diagnostics
We examine your spermiogram according to recognized medical standards and can directly follow up with further examinations if necessary.
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Certified Quality
Regular internal quality controls as well as external quality controls (QuaDeGa round robin tests) ensure consistently high quality of our diagnostics.
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Discreet Sample Collection
The semen sample can be collected discreetly on our premises or, by prior arrangement, at home.
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In-house Andrology Laboratory
Sperm diagnostics and preparation take place directly in our own laboratory – without external routes for fast, reliable evaluation.
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Personal Medical Classification
Our doctors will discuss the results with you in an understandable way and, if necessary, recommend the individually appropriate next diagnostic or therapeutic steps.
Costs for Diagnostic Examinations
The costs depend on the respective examination. All diagnostic services are performed in our own andrology laboratory and evaluated by specialists.
The semen sample can be collected discreetly at our facility or at home. For home collection, the sample must be brought to us body-warm and within a maximum of 40 minutes. Upon request, we will send you a suitable sample container in advance; additional shipping and packaging costs will apply.
The analysis is carried out directly in our andrology laboratory. You will receive your findings encrypted by email within a few days.
Book an appointmentThe test examines the quality of the sperm’s genetic material and can also detect abnormalities that are not visible in a classical spermiogram. The prerequisite for this examination alone is a spermiogram performed by us that is no older than six weeks.
Book an appointmentThe HBA test examines the proportion of mature sperm that can bind to hyaluronic acid. It thus provides additional information about the functional maturity of sperm, which is not covered in a classical spermiogram.
Book an appointmentThe CatSper test examines an important function of sperm that is necessary for penetration into the egg and thus for natural fertilization. A CatSper dysfunction is not recognizable in a classical spermiogram.
Book an appointmentNo fixed or flat-rate prices: We bill on the basis of the official scale of fees for doctors (GOÄ). According to the GOÄ, we are not allowed to quote fixed or flat-rate prices for medical services. The prices mentioned are intended to provide orientation and are typical for the treatments mentioned.
Possible VAT liability: Medical services may be subject to VAT (currently 19%). This applies if, after diagnostics have been carried out, no medical indication or confirmed diagnosis is present and it is therefore not a medical treatment in the strict sense. This can be the case in particular with social freezing treatments, but also with the treatment of single moms and same-sex couples.
We would be happy to provide you with detailed cost information for the planned treatment in advance. This allows you to clarify cost coverage with your private health insurance (PKV) as best as possible beforehand. Statutory health insurance (GKV) does not cover costs at our center.
What Treatment Options are Available for Male Fertility Disorders?
Treatment options for impaired male fertility depend on the underlying cause. In many cases, physical or hormonal changes can be specifically treated.
Infections of the testicles or prostate – even previously unnoticed ones – can often be treated with medication. Hormonal disorders, for example in the thyroid gland or pituitary gland, can be compensated for by individually adapted therapies.
If the desired success does not occur or if there is no clearly treatable cause, reproductive medicine procedures can increase the chances of pregnancy.
During insemination, sperm are prepared in a special laboratory procedure. The most motile and highest quality sperm are selected and introduced directly into the uterus with a fine catheter. This procedure is suitable if sperm quality is only slightly impaired and the partner’s fallopian tubes are patent.
In IVF, sperm are brought together with eggs previously retrieved during treatment in the laboratory. This procedure is an option, among other things, if the partner’s fallopian tubes are blocked or other reasons argue against insemination. IVF can also be useful for slightly to moderately impaired sperm quality.
Intracytoplasmic Sperm Injection (ICSI) is a further development of IVF. A single sperm is injected directly into the egg under the microscope – especially when sperm quality is impaired or IVF has not been successful previously.
If no sperm are detectable in the ejaculate (azoospermia), sperm can be obtained directly from testicular tissue by means of a testicular biopsy (TESE). The extracted sperm can be used for ICSI treatment or cryopreserved. If no sperm are found even then, sperm donation may be considered as an alternative in certain cases.
What Our Patients Say
Frequently Asked Questions about Male Infertility
How is male infertility recognized?
Impaired fertility in men usually causes no symptoms and therefore often goes unnoticed for a long time. Indications can be, for example, changes in the testicle, a varicocele, hormonal abnormalities, or discomfort in the genital area. Whether male fertility is impaired can best be determined by a spermiogram and, if necessary, further examinations.
When should a man have his fertility examined?
If pregnancy does not occur despite regular unprotected intercourse, both partners should generally be examined. An evaluation is usually recommended after twelve months, or after six months if the partner is aged 35 or older. In the presence of known risk factors or a notable medical history, an earlier examination may be advisable.
However, many men also want to have their fertility checked before or at the beginning of their desire to conceive. A spermiogram is a simple examination and can provide an initial assessment of male fertility early on.
How common is infertility in men?
Male factors play an important role in unfulfilled desire to conceive. In about half of affected couples, a male cause or co-cause is found. Therefore, diagnostics for both women and men should ideally be carried out jointly from the outset.
What does OAT syndrome mean for my fertility?
In OAT syndrome, sperm count, motility, and morphology are simultaneously impaired. How much this reduces the chance of a natural pregnancy depends on the severity. However, OAT syndrome does not automatically mean that natural pregnancy is impossible.
Can one get pregnant despite a poor spermiogram?
Yes. Even with impaired spermiogram values, a natural pregnancy may be possible. Crucial factors include the type and severity of the abnormalities, as well as the partner’s fertility. In cases of more severe impairments, fertility treatments such as insemination, IVF, or ICSI can increase the chances of pregnancy.
Can a poor spermiogram improve again?
Yes, spermiogram values can fluctuate and also improve again. Febrile illnesses, medications, smoking, severe overweight, heat, or other factors can temporarily impair sperm quality. Therefore, a follow-up examination is advisable in case of an abnormal finding.
Why are fertility disorders increasing in men?
Large studies show that the average sperm concentration in many countries has significantly decreased over the past decades. The exact causes for this are not yet conclusively clarified. Environmental and lifestyle factors, overweight, smoking, and hormonally active chemicals are among the discussed factors.
What treatment options are available for impaired male fertility?
Treatment depends on the cause and extent of the impairment. Possible options include lifestyle changes, treatment of hormonal or urological causes, and – depending on the spermiogram and the couple’s situation – insemination, IVF, or ICSI.
