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Fertility disorders affect millions of couples. In Germany alone, around 15% of all married couples are unintentionally childless. About 40% of this unwanted childlessness is due to fertility problems in men and in 40% to problems in women. In the remaining 20%, problems between men and women are common. According to the World Health Organization (WHO), this is referred to as primary sterility, that is to say mainly unwanted sterility, if, despite regular sexual intercourse, no pregnancy has occurred after 2 years.

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Male infertility survey

So every couple should take these 2 years before seeking medical help. Since a man's clarification is less complicated, he must first be examined for fertility by a urologist. The most important examination method is the analysis of the ejaculate for the number, mobility and shape of the sperm it contains. The ejaculate is obtained through masturbation, which ideally takes place in a closed practice room. Men should not have had an ejaculation 5 days before this test so as not to affect the results.

Hormonal analysis and spermogram

In addition to the spermiogram, hormonal analyzes are also carried out, with particularly important testosterone and FSH values. A high level of FSH in the blood indicates that the testicular tissue that produces sperm is irreparably damaged, although the general rule is that the higher the value of FSH in the blood (normal <10 IU / L), the greater the damage. to testicular tissue are important.

Ultrasound examination of the tests in infertility

Ultrasound examination of the testes is also very important. This helps to detect changes in testicular tissue, especially testicular tumors. This is important because men with fertility issues have an increased risk of developing testicular cancer, especially if there was an undescended testicle (cryptorchidism) in childhood.

As part of the ultrasound examination of the testes, a duplex ultrasound of the testicular vessels is also performed, e.g. to find out about varicose veins (varicocele), which is one of the most common causes of male infertility.

Extensive functional tests with spermiogram or hormonal analysis then complete the complete clarification program for men, depending on the findings previously made.

The spermiogram

A normal spermiogram (normozoospermia) according to the WHO (World Health Authority) is used if the following parameters are available: See table "New reference values ​​for the spermiogram according to WHO 2010"

• Medical nomenclature to categorize the spermogram:
• Normozoospermia: normal
• Medical nomenclature to categorize the spermogram:
• Normozoospermia: normal
• Ejaculation parameters for oligozoospermia: too few sperm (<15 million / ml)
• Asthenozoospermia: decreased motility (<32%)
• Teratozoospermia: too few normal-shaped sperm
• Oligo-astheno-teratozoospermia: too few spermatozoa, too few
• (OAT): Motility and too little normal form
• Cryptozoospermia: less than 1 million sperm / ml
• Necrozoospermia: only dead sperm, i.e. not motile
• Parvesemia: too low ejaculation volume (<1.5 ml)
• Azoospermia: no sperm in the ejaculate
• Aspermia: no ejaculate / sperm

Human fertility

With age, there are age-related changes in the different structures of testicular tissue in men and, most importantly, a decrease in the number of Leydig cells that produce the male sex hormone testosterone, so that 40th to 50th 20% of men suffer from testosterone deficiency (hypogonadism), but spermiogenesis itself remains largely unaffected by the aging process in humans.

This means that a decrease in sperm parameters and function has not yet been proven for the aging man, so the likelihood of pregnancy in couples with older men and young women is similar to that. couples with young men. However, in older men around the age of 50, there is an increase in structural chromosomal changes in the sperm and therefore a higher risk that the children of older men will develop the autosomal dominant disease.

For this reason alone, the American Fertility Society has issued a recommendation that sperm donors should not be over the age of 50. However, the rare overall risk of a child of a 50-year-old father having a genetic defect is only twice that of a 25-year-old father.

Causes of male infertility (infertility)

A variety of possible causes can lead to restriction of fertility (infertility) in men and thus prevent a desire to have children:

Testicular disorders causing male infertility: undescended testes (cryptorchidism)

In the case of undescended testes (technical language: cryptorchidism), the testis is not in the scrotum at birth but either in the inguinal canal or in the abdominal cavity (what is called the abdominal testis). In normally born mature newborns, an undescended testis (cryptorchidism) can be found on one or both sides in about 2-3% of cases, so that in more than half of these mature newborns, the testicle slips spontaneously over the next 3 to 6 months (this is called Descensus) enters the scrotum.

In premature newborns, there is up to 20-30% testes (cryptorchidism), but in most cases, there is spontaneous descensus in the first months after birth.

Testicular hypertension is also more common in boys with disorders of hormonal secretion in the hypothalamic-pituitary region (hypogonadotropic hypogonadism) against the background of various complexes of rare malformations, the most common of which is Kalmann syndrome, a combination altered olfactory functions (anosmia - the Affected patients can not smell) and hypogonadotropic hypogonadism.

If there is no spontaneous descent (descensus) of the testes until the end of the first year of life, the undescended testes should be treated. If this hour is missed, there is usually an irreparable impairment in the subsequent production of sperm (spermiogenesis) and therefore infertility (infertility) in old age.

In the case of undescended testes (cryptorchidism), a so-called hormonal regimen can be mainly used either with 500 IU of HCG (human chorionic gonadotropin) in a syringe once a week for 5 weeks or with GnRH (hormones releasing gonadotropin) in a nasal spray, 3 times a day 200 µg (a total of 1.2 mg/day) sprayed into each nostril for 4 weeks, however, such "hormonal treatments" only lead to 20-30% testicular descent (spontaneous descensus). The majority of boys with undescended testicles require surgical therapy by bringing the high-level testicle back into the scrotum through a groin incision (called orchidopexy).