Male Infertility: Everything you need to know about infertility in men

Genetic mutation, obstruction of the channels, hormonal imbalance, erectile dysfunction, ejaculation disorders, sperm abnormalities: in total, 30% of infertility cases are of male origin. Between clinical examination and spermogram, how do doctors make their diagnosis? Antibiotic therapy , surgery or ART: what treatment against male infertility can be offered? We tell you everything you need to know about male infertility.

What are male infertility symptoms?

Male infertility symptoms include-

Certain clinical signs may be indicative of dysfunctions associated with low fertility. It can be, among other things, swelling or pain in the testicles, urination problems, urethral flow etc. In most cases, male infertility is discreet, even "silent". It is therefore the inability to conceive a child (after one year of regular and unprotected intercourse) that constitutes the main symptom of male infertility.   

Causes of male infertility-

The causes of male infertility can be:

• Infectious (urinary tract infection caused by a staph, prostate infection, even sexually transmitted infection such as chlamydia);
• Genetics (genetic disorders of spermatogenesis such as Klinefelter syndrome, Y chromosome microdeletion or cystic fibrosis);
• Organic (cryptorchidism);
• Traumatic or neurological (sequelae following medical treatment such as chemotherapy and radiotherapy, vasectomy, anejaculation or retrograde ejaculation caused by damage to the spinal cord, etc.);
• Immunological (anti-sperm antibodies);
• Toxic (environmental factors, endocrine disruptors, alcohol, tobacco, drugs, etc.)
• Central (causing hormonal changes such as hypogonadotropic hypogonadism)
• Vascular (varicocele).

Male infertility Treatment: the clinical examination and the spermogram

Male infertility Treatment include-

In order to offer the best treatment for male infertility, the specialist prescribes a number of analyzes, including a clinical examination. At this point, several criteria are reviewed, such as the patient's weight and height, as well as his blood pressure. Attention is also drawn to possible signs of hypospadias (malformation of the urethra), urinary tract infection or urethritis, surgical history, varicocele, or even gynecomastia (excessive development of the mammary glands). The clinical examination may be supplemented depending on the case by:

• An ultrasound of the testicles and genital tract;
• Hormonal exploration;

Beyond these analyzes, the fundamental examination to explore male fertility remains the spermogram . Here, three parameters are studied:

• The concentration of sperm (search for oligospermia, when the number of sperm is less than 15 million / ml, or search for azoospermia, when the sperm are completely absent from the ejaculate);
• Mobility of sperm (search for asthenozoospermia, when mobility of sperm is reduced);
• Sperm morphology (search for teratozoospermia, when the number of morphologically abnormal spermatozoa is high).

Treatment of male infertility-

Surgery can also find its indication in certain physiological manifestations such as:

• Epididymal obstruction (proposed treatment: epididymo-deferential anastomosis allowing the restoration of communication between the vas deferens and the epididymis);
• Vasectomy (proposed treatment: restorative surgery to restore the permeability of the vas deferens);
• Testicular varicocele (proposed treatment: embolization of the spermatic vein in its upper portion to avoid blood reflux).

Treatment of male infertility: ART responses-

When medical or surgical treatments are not possible, ART remains the best option. At IVF centres, different methods of treatment against male infertility can be proposed. These include:

Artificial insemination (AI) (the oldest and simplest method of assisted reproductive technology) increases the chances of fertilization by placing the sperm in the uterine cavity. This procedure is performed either with the patient's sperm or with the donor sperm.

The ICSI (in English Intra Cytoplasmic Sperm Injection ) or intracytoplasmic micro-injection consists in putting in direct contact an oocyte and a spermatozoon selected for its fertilizing capacity. This targeted in vitro fertilization requires a semen sample by natural route or by testicular biopsy. Facilitating the fertilization process, this process is perfectly suited to cases of oligospermia (low sperm count), asthenozoospermia (low mobility of sperm) or teratozoospermia (sperm of abnormal shape) .

IVF Genetic, combining IVF (in vitro fertilization) and PGT-A (preimplantation genetic test to detect aneuploidies) makes it possible to rule out embryos with chromosomal abnormalities (Down, Turner or Klinefelter syndrome).

The sperm donation is recommended in particular in case of detection of significant pathology, absence of spermatozoa in the ejaculate or in the testicular biopsy, chromosomal abnormalities of the sperm.