When the desire for children and fertility don't match
Infertility , often referred to as "unfertility," means that a couple is unable to conceive a child over a period of twelve months despite regular, unprotected intercourse. In approximately 30-40% of cases, the primary cause lies with the man, for example, due to a low sperm count, reduced motility, or structural changes.
For many men, this term is emotionally burdensome: it raises questions about masculinity, self-esteem, and relationships. At the same time, it is medically clearly addressable with targeted laboratory analysis, lifestyle optimization, medical care, and, if necessary, medically supervised treatment.
Causes of male infertility
Male infertility can have many causes; often several factors work together:
- Hormonal disorders (e.g., low testosterone, elevated estradiol, LH/FSH axis imbalances)
- Anatomical changes (e.g. undescended testicles, varicocele, or due to injuries)
- Genetic factors (e.g., Klinefelter syndrome, CFTR mutations)
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Environmental and lifestyle factors
- Smoking, alcohol, obesity
- Heat stress (e.g. sauna, tight underwear, laptop on lap)
- Infections or inflammations (e.g., orchitis, sexually transmitted diseases)
- Vasectomy or other surgical procedures
Vasectomy and infertility: A podcast recommendation
For many men, a vasectomy is a conscious decision – for example, after completing their family planning. In the men's health podcast ( "Fertility Control for Men," episode 52 ), Prof. Dr. Gralf Popken explains how the procedure is performed, that it has no effect on potency, libido, or testosterone levels – but a very reliable effect on fertility.
Symptoms and signs of male infertility
Men often don't notice existing infertility directly; it usually comes to light through a partner's diagnosis or a failure to conceive. Indirect signs can include:
- Consistently low sperm quality (e.g., low motility, low concentration)
- Testicular shrinkage or asymmetry
- Hormonal symptoms such as loss of libido, fatigue, and exercise resistance
- Family history or existing diseases of the gonads
Diagnostics in cases of suspected infertility
The diagnostic process should be systematic and interdisciplinary:
- Sperm analysis (multiple times, according to standard protocol)
- Hormone status : including testosterone, free testosterone, LH, FSH, SHBG, estradiol
- Imaging in cases of suspected varicocele or varix: Ultrasound of the testicles
- Genetic testing in case of abnormal sperm analysis or small testicles
- Detailed medical history regarding lifestyle, erectile function, surgeries, and medications.
What men can do: Preventive & supportive measures
- Lifestyle optimization : Sufficient sleep, anti-inflammatory diet, exercise
- Reduction of heat stress on the testicles (e.g., no seat heating during long car journeys)
- Micronutrient check & possible supplementation (folic acid, zinc, omega-3, vitamin D)
- Stress prevention : Lowering cortisol, improving sleep quality
- Regular monitoring of important values such as testosterone, homocysteine or CRP
- Partner counseling and, if necessary, psychological support – for mental stability
- In specific cases: Medically supervised hormone replacement therapy , with a clear indication.
Conclusion
Infertility does not automatically mean permanent infertility. Many causes are treatable, whether hormonal, surgical, or through lifestyle changes. An early check-up can not only provide clarity but, above all, open up options – from therapy to vasectomy reversal.
Tip: The podcast episode "Fertility Control for Men" with Prof. Popken offers valuable insights into vasectomy, its effects and the possibilities of reversal - definitely worth listening to if you are dealing with this topic.
