Infertility
Unwanted childlessness - Male infertility
A couple is fertile if the woman gets pregnant after one or two years of regular sexual intercourse. If this is not the case, they may suffer from impaired fertility or infertility. The causes may lie with the woman (30%), with the man (30%), or with both (30%).
Possible causes include the following.
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The quality of the sperm:
- not enough sperm cells are produced (oligospermia)
- no sperm cells at all (azoospermia)
- immobile sperm (asthenozoospermia)
- abnormal sperm (teratozoospermia)
These problems lead to a reduced chance of fertilisation. The poor quality of the sperm is caused by disruptions in the production of the sperm cells or the transport of these.
- Certain contagious diseases (e.g. gonorrhoea or chlamydia) can affect the genitals or cause an infection of the scrotums (mumps during puberty).
- There may also be endocrine disorders. There is then an insufficient production of the hormones that regulate the discharge of testosterone and the production of sperm cells.
- Hereditary anatomical abnormalities such as the absence of sperm ducts or undescended testicles may reduce fertility. The fertility of men that have a single undescended testicle is usually significant: 60-70% appear to be able to father a child naturally. In the case of double undescended testicles, this is only 30%.
- Dilated veins in the scrotal sac (varicocele) raises the temperature in the scrotal sac which may reduce fertility.
- Trauma to the testicle, twisting of the testicle (torsion) or a malignant tumour in the testicle all lead to a reduction in the sperm cell production.
- Some men’s fertility problems may be caused by ejaculation disorders such as an erectile dysfunction or premature ejaculation. In some cases the sperm is not ejected outside but runs backwards and ends up in the bladder. This is called retrograde ejaculation.
- Harmful substances for sperm cell production such as chemotherapy and radiotherapy.
- Chronic illness often leads to poor sperm quality. When suffering a fever, the number of sperm cells can drop to almost nothing.
What can be done to improve the quality of the sperm?
- People should know that 85% of the couples spontaneously become parents within one year.
- To improve your chances, make love two days before and three days after ovulation. Abstain for one or two days. In other words, have intercourse every other day during ovulation.
- Take action quickly. Women’s fertility gradually reduces after the age of 30 years. This reduction drops dramatically after 39 years and the percentage of success with IVF is less than 10%.
- Avoid tobacco, alcohol and caffeine. These toxins affect the fertility of both men and women.
- Watch your weight. Overweight or underweight strongly reduce fertility.
What the urologist will do:
The doctor will examine your scrotums to determine their thickness and volume, to check the presence and the regularity of the discharge channels and to rule out potential varicose veins (varicocele). The hormonal status will also be checked and the semen analysis checked to determine the number, the motility and the vitality of the sperm cells. A second check-up is always needed in case the semen analysis shown any anomalies.
Treatment
The treatment depends on the cause of the infertility. Some of the options are as follows.
- Treatment of an inflammation to the urinary tract and the genitals. A chronic inflammation of the urinary tract and the genitals can lead to poor sperm because of the formation of waste products resulting from the inflammatory response. This will affect the quality of the sperm cells, may lead to the formation of antibodies against sperm cells and thus to the reduction in the ability to fertilise. Treatment with antibiotics, sometimes used for a long time, is a proven treatment.
- Hormonal disorder. A tumour, mostly benign, in the hypophysis damages the hypophysis tissue to such an extent that not enough hormones are produced to ensure a good sperm cell production.
- Retrograde ejaculation. In retrograde ejaculation, the bladder neck cannot close or insufficiently closes and the sperm drain to the bladder. To maintain the quality of the sperm cells, one or more bicarbonate tablets are prescribed to improve the acidity of the urine. Retrograde ejaculation can also be treated with bladder neck strengthening medicines such as ephedrine or imipramine.
- Vasectomy reversal. After vasectomy reversal operations, sperm cells are found in the sperm of 80% to 90% of the men who have undergone surgery. An average of 50% of the couples get pregnant. However, this percentage is lower if there is a long time between the sterilisation and the vasectomy reversal operation.
- Varicocele (varicose veins). The benefit of surgical correction of varicose veins is doubtful. The improved quality of the sperm is seen in 13% of the men.
