The male factor contributes to 50% of infertility cases. In one third of the cases of infertility, the reproductive status of the female partner is normal and 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.
Asked by this means, Leen Antonio answers about the alterations that lead to infertility among men, including the influence of the decline in sperm quality, as well as possible treatments.
Main causes of infertility
Among the main medical causes, 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.. Additionally, obesity and other lifestyle factors (such as smoking or excessive alcohol consumption) can contribute to decreased semen quality.”
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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 both 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, leading the main focus to investigate and treat 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 requires 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 their team,” she says.
Sperm 'apocalypse'?
Regarding the trend that seems to be leading us towards 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, lists the specialist. This includes both lifestyle factors (smoking, excess alcohol, obesity, among others), and environmental factors (endocrine disruptors or chemical substances).
“The impact of declining 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,” he 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 to have high-quality clinical trials on male infertility, which improve the 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.”