Male infertility, unspeakable pain

Among German couples aged 25 to 59 who are willing to give birth, about one in ten cannot conceive naturally. The problem may lie with either party, but the impact of male infertility is clearly underestimated by the scientific community for a long time. Nowadays, the semen concentration of men in Europe, North America, Australia and New Zealand is continuously decreasing. In 1973, each milliliter of semen contained an average of 99 million sperm. In 2011, it became 47 million. According to the standards of the World Health Organization, 15 million spermatozoa per milliliter of semen is still normal. In theory, even if there are only 2 million sperm per milliliter of semen, the egg can be successfully conceived. According to the current development rate, it is estimated that by 2034, the sperm concentration will drop to this value.

However, isn’t it generally said that men are fertile for life? Women may no longer ovulate, but men will produce sperm? British rock singer Mick Jagger gave birth to his eighth child at the age of 73. Is it just a fluke “winning”?

The answer is that a man’s fertility depends not only on the number of sperm, but also on the quality of sperm. Only sperm that can swim forward can reach the egg. In addition, they must also look good. The World Health Organization has also set standard values ​​for this. The number of sperm that can swim forward must account for 32%, and the “face value” must account for 4%. Currently, the World Health Organization has lowered these two values. In other words, according to official standards, a man’s sperm deformity rate can be as high as 96% without being considered to have any problems. If it is a bull with such a high rate of sperm deformity, no farmer would want it. In Switzerland, 60% of 18-22-year-old men do not meet a certain WHO standard for sperm.

| Gene defect |
Andrea Zalzbron said that in the past, men would come to her clinic in a tight dress so as not to be recognized. And now, they even join the carpool. However, according to statistics, infertile men who go to the hospital to rule out organic causes still account for only 6%. These men often embark on a difficult journey of treatment. Some end up lucky, while others suffer miserable failures.

For infertile couples, the cause of the woman is generally investigated first, and only when it is found to be fruitless, will it be thought of whether it is the man’s problem.

Zalzbronn works in the andrology department of Hamburg-Eppendorf University Hospital. On this day, a semen sample was delivered, which belonged to a man born in 1990. Under the microscope in the laboratory, she and her colleagues observed many abnormal sperm. Zalzbron said: “The neck of this sperm is too thick; the tail of this is skewed, the head is too pointed, and there is a depression; the tail of this is curled…” The sperm moves on the tail, and the sperm with a curled tail can only go around. I can’t move forward as I spin around. In the end, Salzbron’s colleagues concluded: “There are too few sperm with up to standard morphology.”

The man was seriously ill, but Zalzbron said that even if he was not ill, his sperm would be what he is now. Symptoms of leukemia can appear on the genitals, but many other cancers, such as this man’s one, are not. The test result of this semen sample is: the normal rate is about 1%. With the help of assisted reproductive technology, this man may also have his own child. The semen is packed in small tubes and frozen in liquid nitrogen at minus 196 degrees Celsius. When needed, high-quality sperm will be taken out to combine with the female egg.

Zalzbron’s first concern was sperm count, motility, and morphology, but genes were also important. Her new artificial intelligence instrument can already detect whether the DNA chain is intact and the outer shell is intact. On the display screen, you can see many small dots, that is the head of the sperm. The blue-green one has an intact DNA shell, while the light orange one does not. If the DNA strand is broken, these sperm will glow.

Sperm Bank in Aarhus, Denmark

On average, the sperm gene defect rate in men today is about 10% to 20%. The clinical diagnosis is divided into “asthenospermia” (too many sperm inactive), “teratozoospermia” (too many abnormal sperm) and “oligospermia” (too few sperm). Zalzbron met men who broke down and cried or ran out in anger after knowing the diagnosis, met women who broke up with men while still in the hospital, and sent his patients to the suicide clinic opposite.

| Causes of infertility |

Why is the shape, quantity and vitality of sperm now worrying? Is it because the jeans are too tight, the testicles are squeezed, the bath temperature is too high, or is it the cell phone in the pocket of the pants or the laptop on the lap?

In this regard, there are various conjectures in the medical field. Zalzbron said: “A common hypothesis is that plasticizers in plastic bottles, glues, and antiperspirants affect the male hormone system and cause estrogen effects. The sensitive period of fetal testicular development is in the sixth pregnancy. Seven weeks. At that time, women often don’t know that they are pregnant, and may inadvertently make the wrong decision.”

For infertile couples, the cause of the woman is generally investigated first, and only when it is found to be fruitless, will it be thought of whether it is the man’s problem. At the Hamburg Fertility Center, Wolfgang Schultz is also looking for causes of male infertility. Most of the couples who came to see him were couples who had tried various methods but were still unable to conceive a child. They learned his name from Facebook or fertility forums. Schultz said that the situation of contemporary men is completely catastrophic. As many as 85% of sperm cannot fertilize an egg.

What happened? The average age of male and female patients who come to his clinic is increasing. “From the age of 40, male fertility will also decline.” Schultz said. He suspects that the problem is not with plasticizers, and believes that these clichés have not been fully confirmed so far. Researchers spread such theories because focusing on environmental factors allows them to obtain research funding.

Schultz believes that the decline in sperm quality is the result of natural self-regulation. He said: “Cell necrosis occurs naturally. Under certain conditions, the cell receives a signal:’Death! We call it’apoptosis. I guess that the improvement of people’s living standards leads to an increase in the number of apoptotic sperm. They can’t fertilize their eggs. People in highly developed countries live well, have a long life span, and don’t have the physical pressure to reproduce. This is completely different from the post-war period or the epidemic period.”

When Schultz was born, there were 2.5 billion people in the world. There are currently 7.8 billion people, and 80 million newborns are born every year. Schultz said: “It can even be said that the current fertility rate has fallen too slowly.” Of course, despite this, he is still trying to find healthy sperm for every man, like finding an oasis in the desert. He has surgery two days a week in the morning, and a testicular biopsy for sperm retrieval takes 30 minutes. A man had only a small amount of sperm in his semen. His wife had miscarried twice. Fortunately, Schultz successfully retrieved healthy sperm for him. In the semen of another patient, Schultz found nothing.

| Unspeakable Hidden |
Male infertility is a taboo topic, because in our society, fertility reflects whether it is strong or not, and the role of father is equivalent to masculinity. When we hear “infertility”, we think of “incompetence”. Generally speaking, a man does not suspect that his sperm quality is problematic. Everyone is more willing to be a hero than a loser.

Infertility has nothing to do with sexual function, but there are still many men who think this defect is degrading and it is best to keep it secret. 41% of infertile men claim that they just haven’t found a suitable partner. Some women will say in the circle of friends that it is their own problem that they can’t give birth, although it is actually their husband’s fault. Infertility makes some men suffer from nightmares, which is a physical defect that every man subconsciously wants to get rid of.

“It is easier for men to admit that they are gay than to admit that they are infertile.” Family therapist Petra Ton said. Since 1993, she has provided social psychology consultations on reproductive wishes, and is committed to de-stigmatizing families who have children through sperm donation. She wrote a book on the subject of “male infertility and willingness to reproduce”. In our world, there are politicians and football stars who admit that they are gay, but very few celebrities will openly admit that they are sterile like the German film director Wim Wenders. The reason for Wenders’ infertility may be that he had mumps when he was a child. Ton hopes that there will be more role models like Wenders to improve people’s acceptance of male infertility and reduce the stigma of infertile men.

Sperm research in the laboratory “too few normal morphology.”

Sociologist Hans Beltram said: “We generally believe that a man must be the father of a child and bear the responsibility of supporting the family. But in fact, this role concept is not since ancient times, but is accompanied by industry. It was born of the advent of society. We took the prevailing principles at the end of the 19th century and the beginning of the 20th century as a standard, and naturally accepted it. Therefore, our associations of masculinity and the role of father are all acquired.”

Most German men want to have their own children and have their own ideas about how to realize the role of father. They provide support when their wives give birth, change diapers, walk with strollers, play with young children, and worry about adolescent children. Men want to be successful in the workplace, but also want to support their partners and participate in the growth of their children.

Beltram said: “We gradually accepted that women can have no children. For men, there is no such tolerance.” He said that young people will refer to their parents’ experiences when making life plans. The difference is that the parents’ generation is more fertile.

| Psychotherapy |
In front of the office of the psychotherapist Tevez Weissman at the Heidelberg University Hospital, there are two chairs and a low table. There are some brochures and books on the table, such as “Farewell to Family Dream” and “Infertility” Counseling and treatment of infertile couples.

Wisman has conducted social psychology research on fertility disorders, and has provided counseling for infertile couples for more than 20 years to help them overcome grief. This is a good-sounding man with glasses and a beard on his chin. The curtains of his consultation room were closed tightly, and the double doors ensured that no one in the corridor could hear the sounds inside.

The persuasion that infertile couples often hear is: “You are too tired at work, go on vacation, relax, you can definitely do it.” 1/5 of infertile men think that they can’t have children because of them. Workplace pressure is too great. In this regard, Weissman said that mental state has no effect on fertility.

In the past, most of the men accompanied their wives into the consultation room, but now the opposite situation is increasing. He said: “The diagnosis of infertility has the same impact as the news of the death of a loved one or that you have cancer.” In the process, men and women feel the same, and there is no difference between men and women’s pain. Some couples will part ways in a crisis, and many will face it together.

Recently, a couple from the Black Forest came to his consultation room. They have been pregnant for a year, but have not been pregnant, and finally found out that the husband was infertile. The 36-year-old man seemed to fall into the abyss all of a sudden, in extreme pain. Wissman let them talk first. The man said that infertility was like a blow to the head, which made him feel like a failure and a deep sense of guilt at the same time. He could not imagine what would happen if he could never have offspring, and he even hated all happy parents who are parents. He didn’t want this, but he couldn’t relieve his inner pain.

“Very few couples cry so badly during the consultation process,” Wissman said. “They broke down completely. He was worse than her.”

Wissman suggested that they only focus on their own feelings and must allow themselves to have negative emotions. “If you don’t have one, it’s abnormal.” Finally, he gave them a homework assignment: They have to come up with a plan B for how to continue their lives. The plan B of the couple is like this: find a sperm donor who is similar in height, size, and hobbies to the husband. Wissman said: “Father is first of all a social role. Even if you don’t have your own children, you can form a happy family. This kind of recognition is very important.”

He told them that if there is a need for consultation, they can come again. But after that, they never appeared again.

| Bravely admit |
A patient of Dr. Wolfgang Schultz lives in a rural area and suffers from asthenospermia, which may be caused by varicocele. Excessive blood supply in the testicles leads to excessive local temperature. His brother has the same problem.

After taking a testicular biopsy to obtain a tissue sample, Schultz congratulated the couple. He found some normal sperm in the upper part of the scrotum where the temperature was lower. After the birth of the first child, they told a few close friends about the matter and received good feedback. A female friend told him that she would also send her husband to see a doctor. Later, the whole village knew that he was sterile. “Assisted reproduction? Ah! Can’t you get an erection?” they said. He was shocked by their ignorance, and tried to explain in language that the villagers could understand: “Imagine a gun. It can’t shoot bullets, only gunpowder smoke.”

If they don’t seek medical treatment, they will have no choice but to have children. Their neighbor built a house with three children’s rooms 15 years ago, and these rooms are still vacant. And they were about to give birth to their fourth child, and his daughter, who was almost two years old, was climbing on his knees. He looked at her and smiled, his happy expression seemed to say: Is there anything more important than this?

There is another couple, the man is 37 years old and the woman is 36 years old. There are almost no sperm in men’s semen that can really swim forward. He is 1.94 meters tall, weighs 90 kilograms and loves to ride a motorcycle, said: “I don’t feel like a man at all, because I can’t do the simplest thing in the world.”

They tried artificial insemination but failed. Women count as good days and arrange sex during ovulation. He even drove to her empty office to sleep, just to catch her ovulation. This kind of intimacy for the sake of giving birth quickly made him uninterested. He began to buy drugs to improve sexual function. “And this tortured me even worse. I can’t give birth to a child, and now I can’t even get an erection.” He said. And she said helplessly: “Even if it’s just a hug, you will ask:’It’s time again?”

They tried the technique of intracytoplasmic sperm microinjection, in which a single sperm was injected into the egg to fertilize it with the help of a micromanipulation system. They tried three times, each time costing 2500 euros, but they all failed. They yelled and cried at home. After the third failure, she called her husband at work and yelled for two minutes. After that, she went to see a psychiatrist.

The man’s father has three brothers and sisters, and his sister also has two children. He sat in the living room and asked: “Why me? What did I do wrong?” Now, he sometimes builds a house for the birds in the garage, sometimes cuts wood for the fireplace, drinks four liters of water a day, and never drinks plastic bottled water. Don’t smoke, don’t drink, stand up and work as much as possible, and stop going to the sauna. It can be said that he tried everything possible.

So far, he has spent as much as 20,000 euros on fertility treatment, and their house purchase deposits have been wiped out. They also want to try an intracytoplasmic sperm microinjection technique for another 2500 euros, and an additional 5000 euros for chromosome testing.

He said: “I felt that the places that never hurt before are now beginning to hurt.” For him, sleeping with his wife is still painful. He bought sex toys, but they didn’t work well. He has been pregnant for four years and said sadly: “Not only do I have an empty bank account, but I also have no sexual desire.”

Dr. Schultz of the Hamburg Fertility Center recommended him to take Anastrozole. This kind of pill is generally taken by women with breast cancer after menopause. It can prevent the production of estrogen. It can also be used to improve semen concentration and sperm motility in men. Side effects include vomiting, hair loss, and liver inflammation. The husband took this medicine for breast cancer, hoping that at least one healthy sperm 60 micrometers long would appear in his semen, which would combine with the egg to complete the fertilization.

When can a man become a real man?

“Yeah, when?” He thought about it, and then said, “It was when he became a father, but also when he admitted and said,’I am sterile.”