Male Infertility Diagnosis and Treatment – Dr. Tepeler, MD

What is Infertility?

It is defined as the inability of a couple to have children despite at least 1 year of unprotected regular intercourse. About 15% of couples planning to have children face this problem. About 1 in 5 couples face this problem.

In approximately 20-30% of infertile couples, the problem belongs to the man alone. Male infertility is mentioned as a result of any problem during the production of male sperm, its transport to the female genitalia and its union with the egg.


The main problems can be listed as genetic diseases, hormonal disorders-deficiencies, diseases that hinder the production of healthy sperm in the testis, and disorders in sperm transport.

These disorders alone or in combination can cause male infertility. Apart from these, many factors such as smoking, alcohol consumption, obesity, stress and nutritional disorders contribute to male infertility.

How Does Sperm Production Happen?

In men, the sperm producing organ is the testicles in the egg sac. There are tubules (thin tubes) in the healthy testis. These tubules contain cells that produce sperm and Sertoli cells that support and nourish them.

The organ called the pituitary in the brain acts as the conductor of the hormone-secreting glands in our body. It stimulates sperm production by secreting FSH (follicle stimulating hormone), and testosterone production by secreting LH. Testosterone in the testis is one of the hormones necessary for sperm production.

The sperm produced in the testis comes to the area called the epididymis, located behind the testis, through the thin channels in the testis. The sperms that mature here, gain the ability to move and fertilize, enter the prostate from the inguinal region behind the urinary bladder through a tube called the ductus deferens and are excreted with prostate secretions at the time of orgasm. It takes about 65-72 days for a healthy sperm to be produced.

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How Is Male Infertility Diagnosed?

In order to diagnose male infertility, first of all, the history of the couple is listened to. Relationship duration, how often they are together, chronic diseases of the patient from the past, surgeries, treatments, sexual functions and desire, habits (smoking, alcohol, etc.), profession, work and social life are learned in general terms.

In the physical examination, the testicles are examined. Presence of varicocele, size-volume of testicles, consistency, traces of previous operation (history of undescended testicles?), presence of neurological disease, penis length, abnormal location of the urinary tract (hypospadias, epispadias), secondary sex characteristics (secondary sex characteristics) (hairy, Many conditions such as body structure, voice, development of pouches and penis) are examined with a detailed physical examination.

The first test to be checked in male infertility is sperm count, semen analysis-spermiogram. In cases where low spermiogram is detected, additional hormone analyzes may be requested.

How is Sperm Count Done? What is Sperm Test?

It is the microscopic examination of the semen given after 3-5 days of sexual abstinence (ie, without intercourse or masturbation).

No soap or lubricant should be used during the process. Less than 3 days or longer is not recommended.

The average values in the society are revealed by the epidemiological studies carried out by the World Health Organization (WHO).

Do not make a decision based on a single spermiogram result, but look at the 2nd spermiogram values within 1 month and evaluate them together will make a more accurate decision.

In the spermiogram test, many values such as total amount (volume), sperm density and total amount, sperm motility (motility-percentage ratios), sperm shape (morphology), presence of leukocytes, acidity (pH), presence of fructose are examined.

Need Additional Reviews?

If sperm values are below certain critical values, additional hormone and genetic tests and radiological examinations (ultrasonography) may be needed.

What is Azoospermia?

It is the situation where no sperm cells can be seen in the semen sample given. It is seen in 1% of the society, but in 10-15% of couples who apply to us because they cannot have children. In some of the azoospermic patients, there is no or less sperm production (b), and in some of them, sperm production is sufficient, but there is no sperm in the semen due to obstruction in the sperm ducts (obstructive azopermia).

Treatment in Male Infertility

Treatment planning is made according to the problem determined after the examinations. Microscopic varicocelectomy is recommended in the presence of varicocele, and medical treatment is recommended in hormonal deficiencies.

Hormone Therapy in Male Infertility

The 2 hormones related to sperm production in the testicles are FSH and LH, which are produced from the pituitary gland in the brain. FSH stimulates Sertoli cells in the testis and stimulates sperm production. LH, on the other hand, activates the production of testosterone by stimulating the Leydig cells.

These hormones can be given externally in the treatment of azoospermia due to insufficient sperm production in the testis or in the absence of hormone production from the pituitary (hypogonadotroic hypogonadism). Klinefelter Syndrome also constitutes the patient group who benefit from hormone treatments. These treatments are applied by monitoring in 3-6-12 month follow-ups.

Vitamins, anti-oxidants and food supplements are also used to support hormone therapy.

What are the Conditions that Negatively Affect Sperm Quality? What should couples who want children pay attention to?

Although sperm production in men continues at every age, there will be a decrease in sperm count and quality with advancing age. Apart from this, the sperm production process is affected by many negative environmental factors. The most known ones are exposure to cigarette smoke (direct smoking or being in a smoking environment), obesity, stress, exposure to chemical substances (especially for those working in the paint industry), working in extremely hot environments (mining, iron-steel, bath-sauna workers), direct or Inflammatory diseases that indirectly affect it (orchitis-ovarian inflammation, mumps, covid-19, urethritis-gonorrhea, tuberculosis-tuberculosis), egg failure, varicocele, testicular tumor-surgery, chemotherapy, radiotherapy can be counted.

Couples who want to have children should especially pay attention to their diet, stay away from stress, rest well, do sports and stay away from cigarette smoke.

What are Assisted Reproductive Methods?

Assisted reproductive methods are recommended for couples who cannot conceive naturally. These treatments can be counted as sperm infusion into the uterus (intra uterine insemination; IUI), ovulation-regulating treatments (ovulation induction) or in vitro fertilization (IVF; ICSI) and advanced fertilization treatments.

- Vaccination is the transfer of the sperm of the man into the uterus of the woman after being given hormones and cracking. Thus, more sperm and eggs meet unhindered and the chance of fertilization is increased. With this method, there is a monthly success rate of around 15% and it can be tried for 3-4 months. In couples with low sperm count, 3-4 sessions can be tried, but if unsuccessful, IVF should be tried.

-The other treatment method is IVF (in vitro fertilization), which is popularly known as the in vitro fertilization method. With this method, ovulation is provided with drugs and mature eggs are taken out of the body with a process called OPU (oocyte collection). Under laboratory conditions, an embryo is created by injecting the sperm into the egg (ICSI). Developing healthy embryos are selected and injected into the mother's womb.

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