2023-07-27 08:13:45
Male infertility is only detected in 11% of cases, warns Leen Antonio, a professor at the University of Leuven, and an expert in reproduction. There is evidence to suggest that sperm quality and quantity have declined in recent decades.
The male factor contributes to 50% of infertility cases. In a third of the cases of infertility, the reproductive status of the female partner is normal, the alteration falls on the male partner.
This is stated by Leen Antonio, an endocrinologist and andrologist at the Leuven University Hospitals, in Belgium.
The specialist, also a professor at the Department of Chronic Diseases and Metabolism at the University of Louvain, participated in the last annual meeting of the European Society for Human Reproduction and Embryology, held in Copenhagen, in a presentation on the complexities of organized male infertility by Merck.
Leen Antonio answers about the alterations that lead to infertility among men, including the influence of declining sperm quality, as well as possible treatments.
Main causes of infertility
Among the main medical causes behind male infertility, the andrologist lists “hormonal imbalances, genetic conditions, infections, chronic diseases or certain medications. However, in a large proportion of men with suboptimal semen quality, a specific cause may not be identified. In addition, obesity and other lifestyle factors (such as smoking or excessive alcohol consumption) can contribute to a decrease in semen quality.
Hence, if a couple is experiencing difficulties conceiving, the expert recommends that both members undergo an evaluation and consultation with a fertility specialist.
“This allows for a full assessment of male and female factors, increasing the likelihood of identifying and addressing any underlying male infertility issues. It is crucial to remember that infertility can result from both male and female factors, or a combination of both. Comprehensive fertility evaluations that consider both partners are important in accurately diagnosing and treating infertility problems. It is estimated that male infertility is only detected in 11% of cases.
Andrologists on the team
Why is it that cases of male infertility are not sufficiently diagnosed? The Belgian university professor attributes it, among other things, to the lack of symptoms, “especially if the underlying problem is related to sperm production or function”, but also to the conventionalism by which the causes are first sought in women . “Infertility is often assumed to be a woman’s problem, shifting the main focus to investigating and treating the female partner.” This may partly explain why the masculine factor is overlooked or not given the same attention in the initial evaluation.
Also, remember that this detection and diagnosis require specific tests, such as semen analysis, hormonal evaluations and an examination carried out by an andrologist. “It’s important that fertility clinics also have a male reproductive health specialist on his team,” she says.
Sperm ‘apocalypse’?
Regarding the trend that seems to be leading us to a sperm apocalypse, with the gradual worsening of semen quality, Leen Antonio admits that “there is evidence that suggests that the quality and quantity of sperm has decreased in recent decades. Several studies have reported a decrease in sperm count. However, it is important to note that there is an ongoing debate about the extent and causes of this decline.”
Several factors can contribute to the potential decrease in sperm quality, the specialist lists. This includes both lifestyle factors (smoking, excess alcohol, obesity, among others), and environmental factors (endocrine disruptors or chemical substances).
“The impact of decreased sperm quality on infertility can vary. Poor sperm quality can reduce the chances of successful fertilization and increase the time until pregnancy is achieved, both in spontaneous pregnancy and in medically assisted reproduction, ”she recalls.
Depending on the underlying cause and specific circumstances, there are different treatment options for male infertility.
“However, to date, there are not many medical treatment options for men with impaired semen quality, and the number of high-quality clinical trials is limited. It is important that the choice of fertility treatment is based on the reproductive health parameters of both members of the couple. Not all cases of male infertility can be effectively treated with interventions. The reproductive health of the couple is also important.
For this reason, he stresses the need for high-quality clinical trials on male infertility, which improve understanding of its causes. Studies that include the investigation of genetic factors, epigenetic influences, environmental exposures, lifestyle factors and their impact on sperm production and function.
“There is an unmet need for medical interventions aimed at improving semen quality. We need to identify subgroups of men who may benefit from hormonal treatments to improve semen quality, and we need more data from good quality clinical trials with hormonal treatments.”
He also hopes that advances in diagnostic tests (identification of new biomarkers and improved semen analysis techniques) will take place, so that treatment options can be better adapted.
Regarding assisted reproductive technologies, he adds, “improvements in sperm selection methods may lead to higher success rates, reduced risks, and better outcomes for couples undergoing fertility treatments.”
Options in male infertility
-In men with varicocele, surgery or embolization of the enlarged vein can improve semen quality.
-Making lifestyle changes like quitting smoking, reducing alcohol intake, and maintaining a healthy weight can also help improve semen quality.
-Medications: In cases where hormonal imbalances are affecting fertility, certain medications can be used to restore this balance.
A) Gonadotropins (LH and FSH) are hormones that stimulate sperm production in the testicles. In cases where the pituitary gland does not produce sufficient levels of gonadotropins, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH), this treatment may be prescribed. It involves the administration of exogenous gonadotropins through injections to stimulate the testicles and promote testosterone and/or sperm production.
Human chorionic gonadotropin (hCG) therapy: can be used to stimulate the testicles to produce testosterone when low LH levels lead to low testosterone production. FSH is a hormone that plays a crucial role in the reproductive system of both men and women. In men, FSH is important in supporting sperm production in the testicles. It acts on the Sertoli cells in the testicles, which are crucial in supporting and nourishing developing sperm cells. FSH therapy can be an effective treatment option for male infertility when low sperm production is related to insufficient FSH levels. It is important to note that the appropriateness and effectiveness of this treatment approach depend on the specific underlying cause of infertility and individual circumstances. It is important to consult with a reproductive endocrinologist or an andrologist.
B) Selective estrogen receptor modulators (SERMs) can improve semen quality by stimulating the pituitary gland to produce gonadotropins. Also for these drugs, the appropriateness and effectiveness of this treatment approach depends on the specific underlying cause of infertility and individual circumstances. Its use in men is currently off-label.
C) It is important to know that testosterone injections themselves have a negative impact on sperm production. In order to have optimal sperm production, the testicles need to produce testosterone themselves.
-Assisted reproductive techniques such as IUI, IVF or ICSI can be used if semen parameters cannot be improved with medication or surgery. Sonia Moreno
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