Infertility

Definition

A couple is infertile when no pregnancy takes place after two years of unprotected regular sexual intercourse. In this case, both partners must be evaluated.

Incidence

Approximately 10 to 15% of couples are infertile. The cause lies in approx. 40% in the female, in 30% in the man, and is mixed in 30%.

Sperm production

The male ejaculate consists of sperm and a fluid. This fluid is produced by the efferent sperm channels, seminal vesicles, the prostate, and the Cowper glands in the urethra. The largest portion is produced by the seminal vesicles (60%). The human testis has two functions: one is the production of sperm (spermatogenesis), the other is the production of the male sex hormones, in particular testosterone. The hormonal regulation of sperm development runs over the hypothalamus pituitary-testicularaxis.

Diagnostic procedures

The andrologic examination begins with a detailed case history (puberty and sexual development, previous diseases, infections, surgery, as well as drugs and toxins). This is followed by a general physical examination and then the urological examination of the external and internal genitalia. Laboratory testing includes a spermiogram, determination of blood-hormonal levels and urine analysis, depending on the findings a urine culture, a prostate massage or possibly analysis of postejaculat urine may be needed. Duplex sonography may be necessary to exclude a varicocele (varicosities of the testicle). Further possible examinations include scrotal or transrectal sonography or a testicular biopsy.

Etiology

  1. Hormonal disturbances of congenital origin, tumors or other factors.
  2. Disturbances in spermatogenesis may be due to chromosomal anomalies, certain congenital diseases, testicular infections, all types of testicular damage (toxins, enviromental factors, trauma) defective hormonal synthesis or metabolism, varicocele, cryptorchidism or severely impaired general health.
  3. Disturbances of sperm transport may be congenital, post surgery (vasectomy-sterilization), post traumatic, immunological, or due to bladder neck problems etc.

Treatment

Depending on its cause, treatment may consist of advice as to way of life, medication, a surgical procedure or assisted reproduction.