When should an assessment be made?
The general approach is that both partners are assessed where pregnancy has not occurred within a year despite regular unprotected intercourse. Where the woman is over 35, that period may be shortened to six months.
Where there is a history of undescended testis, testicular injury, inguinal hernia surgery, mumps orchitis, chemotherapy or radiotherapy, or where a marked varicocele has been found, assessment is advised without waiting a year.
The tests performed
Assessment begins with a detailed history and a urological examination. Depending on the situation, the following may then be planned:
- Semen analysis: the first-line test. It gives information on sperm count, motility and shape. A decision is not made on a single result; it is repeated at appropriate intervals.
- Hormone tests: FSH, LH, total testosterone and, where needed, prolactin and thyroid tests.
- Scrotal ultrasound: to assess varicocele, testicular size and any structural problems.
- Genetic tests: where the sperm count is very low or no sperm is present, a karyotype and Y-chromosome microdeletion analysis may be considered.
- Urine testing and, where needed, examination of post-ejaculation urine (if retrograde ejaculation is suspected).
The main causes of male infertility
The causes span a wide range. Among the most common are varicocele, hormonal disorders, past infections, problems related to testicular descent, blockages in the sperm ducts and genetic factors.
Alongside these, modifiable factors matter too: smoking, excessive alcohol, testosterone taken from outside and athletic supplements, exposure to excessive heat, obesity, uncontrolled diabetes and certain medicines can all affect sperm production adversely. Testosterone taken from outside in particular can suppress sperm production and cause a serious fall; this is frequently overlooked.
Treatment steps
Treatment is planned according to the cause identified:
- Addressing modifiable factors: stopping smoking, weight control, discontinuing hormones taken from outside and managing chronic conditions.
- Varicocele surgery: in suitable cases, microsurgical varicocelectomy aims at improvement in sperm parameters; the outcome varies from person to person.
- Hormonal treatment: planned under a physician’s follow-up where a hormonal disorder is confirmed by laboratory testing.
- Treating infection: appropriate treatment of infections affecting the sperm ducts.
- Micro-TESE: a surgical method for retrieving sperm from testicular tissue with the aid of a microscope, in cases where no sperm is present in the semen (azoospermia).
- Assisted reproduction: insemination or IVF, planned together with the assessment on the female side.
The process is planned as a couple
Assessing the male partner alone is not enough. Where the findings on the female side, age and time-related factors are not considered together, time can be lost. Results are therefore best interpreted with the couple as a whole in view.
Information obtained during the assessment is protected under data protection law and is seen only by the relevant clinical team.
Frequently asked questions
How many days of abstinence are needed before a semen analysis?
A period of 2 to 7 days is generally advised. Because shorter or much longer periods can affect the result, it is important to follow the instructions given by the laboratory.
Is a decision made on a single semen test?
No. Sperm parameters can vary over time within the same person. The result is therefore usually interpreted together with measurements repeated at appropriate intervals.
Does varicocele surgery improve the chance of pregnancy?
Improvement in sperm parameters is reported in suitably selected cases; but the outcome varies from person to person and pregnancy cannot be guaranteed. The decision to operate is made by weighing the examination, the sperm results and the partner’s situation together.
If there is no sperm in the semen, is there any chance of having a child?
A diagnosis of azoospermia does not directly mean that having a child is impossible. After investigation aimed at the cause, sperm can in some cases be retrieved from testicular tissue with micro-TESE. That assessment is specific to the individual.
Can taking testosterone cause infertility?
Testosterone taken from outside can suppress the body’s own sperm production and lead to a serious fall in sperm count, or to no sperm being present at all. Anyone planning to have children should not continue such use without their physician’s knowledge.