The clinical definition of infertility hinges on a couple's inability to achieve pregnancy following 12 months of regular unprotected intercourse. How prevalent is infertility? Roughly 15-20% of all couples in the Western world will encounter issues with infertility at some point during their reproductive years. Infertility can be primary, meaning issues conceiving a first child, or secondary, signifying issues conceiving subsequent children.
In at least 50% of couples, male subfertility plays a part in explaining the couple's issues. Therefore, it is nearly always recommended to investigate the male partner as part of the evaluation. The goal of this investigation is to identify underlying causes and present possible treatment options.
Unexplained subfertility (33%)
Varicocele (17%)
Hypogonadism (testosterone deficiency) (10%)
Subclinical infection (9%)
Cryptorchidism (9%)
Ejaculatory disorders (6%)
Genetic disorders (5%)
Immunological factors (4%)
Systemic disease (3%)
Obstructions (2%)
Testicular tumours (0.3%)
Other causes
In 20-25% of all infertile couples, the examination of both the female and male partners does not indicate any abnormality, and the condition is then categorised as unexplained infertility. Approximately 30% of all men with reduced semen quality and infertility show signs of testosterone deficiency.
The only definitive way to determine fertility is through a fertility evaluation. The most significant indicator in such an evaluation is a semen sample. However, suspicion of infertility can be raised if:
You have not achieved pregnancy in the last 12 months despite having unprotected intercourse 2-3 times per week with your partner.
You notice disorders in semen emission or erectile dysfunction.
You can be evaluated for infertility if you have been attempting to conceive through regular, unprotected intercourse for 12 months without success.
You can be evaluated for infertility if you and your partner have experienced 3 consecutive spontaneous miscarriages (abortions) after the 6th week of pregnancy but before the 22nd week. In this case, an investigation for recurrent miscarriages can be initiated, in which an evaluation of the man's fertility may be included.
A fertility evaluation, ideally conducted through a fertility clinic, can be said to comprise 4 stages:
Fertility medical history
Fertility status
Blood tests
Semen sample
A fertility evaluation begins with a fertility medical history, where a doctor poses questions to better understand the possible causes behind the issues. Examples of questions that may be asked include:
How long have you been trying to have a child?
How often do you have intercourse?
Have you ever undergone surgery in the pelvic region?
Have you ever been hospitalised for an illness?
Following the medical history, a status examination is performed by the doctor. This involves measuring testicle volume (normal size being 15-25 mL). A testicle volume under 15 mL in an adult man indicates a defect or lack of gonadotropins. The consistency of the testicles is then examined, followed by a check for possible varicoceles (varicose veins in the scrotum).
In terms of sampling, a fertility evaluation includes blood tests (to be taken while fasting, before 10 a.m.) mainly aimed at assessing your hormonal and metabolic status.
The fourth part of the evaluation (but not necessarily the last to be performed) is a semen sample. This evaluates sperm concentration at two repeated occasions. If the concentration is below 5 x 106/mL or there is any other suspicion of a genetic defect, further testing for chromosomal abnormalities is done.
Depending on the outcomes of the above examinations, further investigations through imaging diagnostics, such as ultrasound, may be required in a subsequent step.
The most crucial action you can take is to ascertain as soon as possible whether your fertility is compromised and seek medical attention if it is. Time is one of the most vital factors when it comes to fertility, and it's one factor that cannot be controlled.
Yes, to some extent. The rule is that you can ALWAYS worsen it, but you may not always be able to improve it.
You can enhance your fertility by adopting healthier habits to replace unhealthy ones. This way, you can avoid lifestyle factors that may negatively affect your fertility.
If you already lead a healthy lifestyle, it can be difficult to do more on your own to improve your fertility. If you suspect your fertility is reduced despite leading a healthy life, you should seek medical care and be evaluated for this.
The factors that can negatively impact your fertility are:
Smoking
Alcohol
Drugs (including anabolic steroids)
Overweight
Unbalanced/unhealthy diet
Age
Lack of exercise
Sexually transmitted diseases
Trauma to the scrotum
Stress
Medications (such as NSAIDs, epilepsy medications and medications for rheumatic diseases)
Cancer treatments
Varicocele (varicose veins in the scrotum)
Congenital conditions like Klinefelter syndrome or testicles that haven't descended into the scrotum
Antibodies against your own sperm
Hot baths and tight trousers
Medical treatment of reduced sperm quality is only relevant for a small proportion of men with fertility problems. Treatment options include:
Hormone injections for patients with lower quality due to, for example, drug use
Medication for men with ejaculation disorders
Discontinuation of medication(s) that may cause fertility issues
Advice regarding sexual frequency and expectancy when the infertility history is relatively short (< 2-3 years), and the couple does not have sex 2-3 times a week.
For most patients, assisted fertilisation (or adoption) is the only option.
Psychological counselling should be offered where it is deemed necessary (as support and not treatment for infertility).
Remember that time is a crucial factor, and the longer you wait to seek treatment and assisted fertilisation, the lower the chances of a successful pregnancy.
Approximately 70% of all couples who undergo assisted fertilisation (3 treatments) succeed in achieving pregnancy. The more treatments, the often higher the probability of having a child.