Over the past few decades, the decline in male fertility has become a well-documented concern. Initially observed in industrialized Western countries, studies revealed a near 50% decrease in sperm concentration and total sperm count over the last 30 years. Now, similar data has emerged from Asia, Africa, and other regions in the Global South, highlighting a global trend: more and more men are struggling to father children. Unfortunately, this issue is compounded by a disturbing lack of clarity surrounding its causes and treatments.
The root of the problem remains elusive. Possible contributing factors range from chemical exposure, including pesticides, to environmental pollution from microplastics and modern lifestyle habits. However, no single cause has been definitively identified, and a cure remains elusive. Adding to the challenge is the stark gap in diagnostic capabilities, leaving many men without answers when they face infertility. The lack of adequate medical care only intensifies the emotional distress for families affected by these struggles.
Rising Numbers and a Call for Change
In response to the growing issue, the German Society of Andrology (DGA), the German Society of Urology (DGU), and the Professional Association of German Urology (BvDU) released a joint statement in November calling for improved care for men with fertility issues. Their aim is to establish standardized medical protocols for male infertility—a crucial step, as such protocols have long been in place for women but are still largely absent for men. Currently, one in six couples in Germany faces involuntary childlessness, and in at least half of these cases, the male partner plays a role in the infertility.
To address this gap, the medical societies have outlined a set of “medically relevant examinations” for infertile men. These measures are intended to streamline care and provide the best possible treatment options for affected individuals. However, one of the key barriers to progress remains the lack of adequate reimbursement by health insurance providers, which often leaves patients to bear the cost of necessary treatments themselves. As a result, the three organizations are also calling for urgent changes in insurance policies to ensure fairer access to care.
The Silent Pandemic: Male Infertility’s Growing Impact
The issue of male infertility has reached pandemic-like proportions, a fact that remains largely underappreciated, even by politicians. Fertility issues are influenced by a range of factors, including socio-economic conditions, environmental pollutants, and genetic factors. As these influences continue to spread, the demand for fertility treatments rises. Despite this, there is still a lack of standardized diagnostic approaches for male infertility, which are essential for making informed treatment decisions for couples.
Professor Sabine Kliesch, head of the DGA, stresses the importance of an interdisciplinary approach to assisted reproductive procedures. The lack of consensus diagnostics for men has led to unnecessary and invasive treatments for women, particularly in cases where male infertility could be addressed. Currently, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments, which are often necessary when male fertility is a factor, remain expensive and only partially covered by health insurance, limiting access for many couples.
Genetic Diagnostics: A Potential Key to Unlocking Solutions
Genetic factors are often at the heart of male infertility issues, particularly in cases of severely reduced sperm count (oligozoospermia) or the complete absence of sperm cells (azoospermia). These genetic causes are thought to account for up to 20% of male infertility cases. Unfortunately, genetic testing is not always performed, leaving many men without a clear understanding of the root cause of their infertility. In some cases, even azoospermia can be treated if sperm can be extracted directly from the testicles, but this requires skilled specialists and a well-informed patient base.
To improve outcomes, the DGA, DGU, and BvDU recommend expanded genetic diagnostics as part of a comprehensive approach to male infertility. They have outlined a series of essential and advanced diagnostic tests, which include a thorough medical history, physical examination, and tests such as sonography to detect issues like varicoceles or testicular tumors. The sperm analysis, in particular, follows WHO standards and serves as a cornerstone for diagnosing fertility issues. Hormonal tests also play a critical role in identifying testicular function disorders.
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