Wie häufig ist männliche Unfruchtbarkeit, und was sind die Ursachen?

What is infertility?

Your fertility is your ability to conceive a baby through unprotected sex: infertility is when this becomes difficult. In most cases, it's not as straightforward as being either fertile or infertile - many factors can decrease, but not completely eliminate, your chances of having a baby.

In both men and women, fertility naturally declines with age, and for partners struggling to become pregnant, there is no clear cut-off point to say when a couple is infertile. Experts usually advise you visit your GP if you've not become pregnant after a year of trying.

Your GP may decide to test one or both of you for possible infertility causes. There are several health issues that can cause male infertility specifically, and finding a diagnosis means you can better understand your options and chances of conceiving naturally.

How common is male infertility?

When it comes to fertility problems, men and women experience them fairly equally. According to a US national survey that spanned almost 20 years, around 9% of men and around 11% of women experience fertility problems¹.

Giulia Guerrini, lead pharmacist of digital pharmacy Medino, says that one in three infertility cases for couples are due to male reproductive issues; one in three infertility cases are caused by female reproductive issues; and the final third is made up of couples who are both diagnosed with health issues affecting fertility, or have both tested but aren't diagnosed with a specific cause².

Guerrini says that despite this even spread of causes, male infertility is a difficult subject for some people to discuss.

What causes male infertility?

What can go wrong in a man's reproductive system - the body parts that allow him to make a baby? Guerrini explains:

"Without giving a full lesson on the birds and the bees, a man's testicles produce and store sperm, which is later ejaculated by the penis to combine with a woman's egg. As such, the majority of male infertility issues are problems that affect how the testicles work."

Testicle problems could reduce or eliminate your number of sperm, make them less mobile, or prevent them from ejaculating. Abnormal sperm doesn't automatically make you 100% infertile - depending on how your sperm is affected, your fertility may be decreased, rather than gone completely.

Diseases and male infertility

There are also several conditions that cause many men to worry over their long-term fertility. Following are a few common examples that demonstrate how the relationship between infertility and disease is rarely simple.

Can testicular cancer cause male infertility?

According to Vincent Wolverson, CEO of testicular cancer charity It's On The Ball, it is relatively rare for this form of cancer to cause male infertility in the long-term. "The majority of men who are treated go on to lead a normal sex life and are able to produce a family, as the remaining testicle will produce healthy sperm."

However, he adds that men who undergo chemotherapy may experience temporary infertility during treatment, and that medical staff will be able to advise on this.

Patientenauswahlen für Fruchtbarkeit

Sexuelle Gesundheit

Why is egg freezing on the rise and is it safe?

In the last decade, the number of women choosing to freeze their eggs has increased tenfold. Egg freezing can offer a great opportunity, but it isn't a fail-safe insurance policy against age-related infertility. To help women decide whether this treatment is right for them and their bodies, they need clarity around egg freezing risks, success rates, and other physical, emotional, and financial factors.

von Amberley Davis

Sexuelle Gesundheit

Unfruchtbarkeit

Unfruchtbarkeit bedeutet, dass es schwierig ist, auf natürlichem Wege schwanger zu werden, obwohl man regelmäßig ungeschützten Geschlechtsverkehr hat und keine Verhütungsmittel verwendet. Es gibt keinen eindeutigen Grenzwert, ab dem ein Paar unfruchtbar ist. Bei vielen Paaren dauert es mehrere Monate, bis sie schwanger werden. Etwa 84 von 100 Paaren werden innerhalb eines Jahres nach dem Versuch schwanger. Etwa 92 von 100 Paaren werden innerhalb von zwei Jahren schwanger. Anders ausgedrückt: Etwa 1 von 7 Paaren wird innerhalb eines Jahres nach dem ersten Versuch nicht schwanger. Mehr als die Hälfte dieser Paare wird jedoch im folgenden Jahr ohne jegliche Behandlung schwanger. Wenn ein Paar trotz regelmäßigem Geschlechtsverkehr nach einem Jahr noch nicht schwanger geworden ist, schlagen die Ärzte in der Regel einige Tests vor. Wenn die Frau älter ist oder wenn es einen offensichtlichen Grund gibt, warum ein bestimmtes Paar nicht schwanger wird, egal wie lange es sich bemüht, können die Tests oder die Behandlung früher beginnen. Es lohnt sich in der Regel, einen Arzt aufzusuchen, wenn Sie nach einem Jahr der Versuche noch nicht schwanger geworden sind. Ein Arzt kann einige häufige Ursachen abklären, die Dinge besprechen und mögliche Optionen erörtern. Es kann sinnvoll sein, den Arzt früher aufzusuchen, wenn die Frau des Paares älter als 36 Jahre ist oder wenn einer der beiden Partner in der Vergangenheit Fruchtbarkeitsprobleme hatte oder an einer Krankheit wie Endometriose oder polyzystischem Ovarialsyndrom leidet, die bekanntermaßen mit Fruchtbarkeitsproblemen in Verbindung stehen.

von Dr. Toni Hazell, MRCGP

Can Crohn's disease cause male infertility?

Crohn's disease, a form of inflammatory bowel disease (IBD), is a long-term condition of the gut. The relationship between IBD and fertility is unclear and more research is needed. It's possible that the gut inflammation, the nutritional deficiencies this causes, and certain treatments including drugs and surgery could potentially impact your fertility when you have Crohn's disease.

It was also found that voluntary childlessness, not infertility, may also be contributing to lower birth rates among patients. The study suggested that this could be due to fears of those with the disease that birth abnormalities could be caused by IBD drugs and concerns of passing on the disease⁶.

Can haemorrhoids cause male infertility?

Haemorrhoids - also called piles - are swollen veins in your anus and lower rectum, similar to varicose veins. While there is no evidence that this directly affects your fertility, studies have linked haemorrhoids with increased rates of erectile dysfunction⁷, preventing you from having sex.

Both complications are treatable, meaning that any infertility troubles are usually temporary and reversible.

Lifestyle causes of male infertility

For around one in four couples struggling to conceive, the problem can't be traced to a single health issue. This may be frustrating, but in these circumstances, doctors usually encourage couples to keep trying. Around half of couples who don't get pregnant within a year will conceive the following year.

To improve your chances, address the unhealthy lifestyle habits that are proven to increase both female and male infertility.

Weitere Lektüre

1. National Health Statistics Report: Infertility and impaired fecundity in the United States, 1982-2010: National Survey of Family Growth.

2. American Urological Association: Diagnosis and treatment of infertility in men: AUA/ASRM guideline 2020.

3. Centers for Disease Control and Prevention: Complications of mumps.

4. NORD: Kallmann syndrome.

5. Mayo Clinic: Klinefelter's syndrome.

6. Gastroenterology & Hepatology: Sexual issues and fertility in male patients with inflammatory bowel disease.

7. Abdelaziz et al: The impact of surgical hemorrhoidectomy on male sexual function: A preliminary study.

8. Tommy's: How smoking affects female and male fertility.