Hypogonadism is an underfunction of the gonads, which can occur in men, for example, in the form of posttesticular hypogonadism. The cause of this fertility disorder lies either in a blockage of the seminal duct or in another motility impairment of the sperm. If motility cannot be restored, artificial insemination takes place.
What is posttesticular hypogonadism?
There are different reasons for infertility and infertility, infertility or sterility. Fertility disorders affect women more often than men. In men, the most common cause of infertility is abnormal sperm count or motility. See healthknowing for What is the Definition of DNA.
Although the woman is more often responsible for childless marriages, male infertility is also a relatively widespread phenomenon. Up to 15 percent of marriages remain childless because of male infertility. Posttesticular hypogonadism is a male fertility disorder associated with impaired motility or obstruction of the seminal ducts.
The seminal ducts are used to transport seminal fluid and are located inside and outside the testicles. Posttesticular hypogonadism accounts for 20 percent of all male infertility cases. Unilateral posttesticular hypogonadism is to be distinguished from bilateral posttesticular hypogonadism. Only the bilateral form actually leads to male infertility.
Two variants of posttesticular hypogonadism exist. While one is caused by the seminal ducts, the other is caused by the motility or composition of the sperm. Hypogonadism is basically to be understood as an underfunction of the gonads. In addition to the primary form, this hypofunction can occur secondarily after a blockage of the seminal ducts, since the blockage damages the testicles.
The cause in the seminal ducts is a congenital or acquired blockage of the efferent ducts. In the congenital form, aplasia or atresia in the ductus deferens or in the epididymal ducts is usually responsible for the phenomenon. The acquired variant may be associated with inflammation or vascular ligation after hernia repair.
If motility disorders are responsible for the infertility, these disorders can be due to different causes. A sperm structural disorder, for example, can cause sperm immobility. The same applies to the wrong composition of the semen, which can occur in the context of inflammation.
Symptoms, Ailments & Signs
Men with posttesticular hypogonadism show a cause-dependent clinical picture. As a rule, the most common symptom is infertility. In most cases, those affected only go to the doctor after their desire to have children remains unfulfilled, even after months or years, despite regular attempts.
All other symptoms of posttesticular hypogonadism cannot be identified for the man and only show up in the clinical analysis of the spermiogram. For example, posttesticular hypogonadism can be characterized by a lack of spermatozoa in the male ejaculate if the seminal ducts are blocked.
This symptom is also known as aspermia. Other stages of seed development can also become scarce if sealed. If, on the other hand, there is a motility disorder, the semen analysis shows spermatozoa that are structurally and motilely restricted.
Depending on the primary cause, accompanying symptoms such as pain may be present. This is the case, for example, with causal inflammation, which can be responsible for the sperm’s lack of mobility.
Diagnosis & course of disease
The diagnosis of posttesticular hypogonadism is made by a fertility doctor. As a rule, those affected turn to a fertility clinic where a spermiogram is created if their desire to have children is unfulfilled in the long term. The spermiogram is collected in the laboratory, whereby the form of posttesticular hypogonadism is to be determined as part of the diagnostics.
If it can be proven that there are no spermatozoa in the sample, the seminal ducts are blocked. If sperm are present but not able to move sufficiently, this is the second variant of the disease. The prognosis depends on the type of posttesticular hypogonadism.
In most cases, this disease leads to infertility in the patient. This does not have to be fully developed, but can lead to an unfulfilled desire to have children. As a rule, however, the person concerned can resort to other methods in order to be able to pursue the desire to have children.
This disease can also lead to severe psychological problems or even depression. Those affected suffer from a significantly reduced self-esteem or from inferiority complexes. The patient’s quality of life is also significantly restricted and reduced in this disease. In many cases, those affected are ashamed of the symptoms of this disease, so that a doctor is not consulted directly.
In some cases, the disease also leads to slight pain in the testicles, which can lead to general irritability. However, there are no other health restrictions. It is usually not possible to treat this disease. With the help of various techniques, a desire to have children can still be pursued. Special complications usually do not arise. The life expectancy of the patient is also not affected.
When should you go to the doctor?
If infertility is suspected, the doctor should be consulted. Posttesticular hypogonadism is generally characterized by a lack of sperm cells in the male ejaculate. Men who do not wish to have children therefore do not necessarily need to seek medical advice. However, if the underlying testosterone deficiency causes further symptoms, it is best to consult a doctor. Men over the age of 30 are particularly at risk. Men who suffer from pre-existing endocrine disorders are also at risk and should consult a specialist if signs of post-testicular hypogonadism appear.
You can visit your family doctor or a urologist. If the symptoms are based on a psychological problem, the doctor will put you in touch with a suitable psychologist or sex therapist. If necessary, couple therapy is also possible if the hypogonadism is related to an unfulfilled desire to have children in the partnership. The syndrome often progresses without clear symptoms and testosterone levels regulate themselves over the years.
Treatment & Therapy
The treatment of fertility disorders is a relatively young therapeutic area. In many cases of hypogonadism, substitution therapy with sex hormones already leads to the desired success. In men, this substitution corresponds to the administration of androgens. Testosterone, DHEA and anabolic steroids come into consideration as active ingredients from the drug group of sex hormones.
If the efferent seminal ducts are blocked, a causal therapy is usually also an option, in which the blockage of the spermatic ducts is surgically resolved. However, this procedure often does not lead to the restoration of the original testicular function. As a rule, the testicles have already suffered irreversible damage as a result of the closure.
If hormone substitution does not work either, sperm motility must be improved. Zinc, for example, can help with this. In most cases, however, artificial insemination is necessary if the motility is continuously restricted. For this purpose, egg cells are removed from the woman and brought into contact with the man’s sperm “in a glass”.
The sperm are often injected directly into the egg cell. This direct injection increases the likelihood that fertilization will be successful despite motility impairment. The woman is reinserted with the fertilized egg and ideally carries the child.
Preventive measures for pottesticular hypogonadism include a healthy and balanced diet. In particular, an adequate supply of zinc contributes to the health of the sperm and gonads. Occlusion-related fertility disorders can be prevented by regularly examining the seminal ducts. If an occlusion that has occurred is noticed in good time and resolved, fertility is generally retained without restriction.
Men who suffer from posttesticular hypogonadism can pay attention to a health-conscious diet as part of the follow-up care. The doctor treating you often recommends taking zinc. The increased intake of zinc improves the mobility and health of the sperm and the seminal ducts are free again. A vitamin-rich diet with sufficient zinc is therefore very helpful.
When it comes to aftercare and prevention, the doctors’ recommendations point in the same direction. In addition, a regular examination of the seminal ducts should take place after a first-time illness. Patients can stimulate this control themselves so that fertility is not impaired. If the therapy is unsuccessful, those affected have to come to terms with their inability to conceive.
Here it makes sense to ward off negative feelings such as shame and inferiority complexes through openness. In the relationship with the partner, patients should be honest and not simply ignore the issue. Otherwise it can even lead to depression or a separation from the partner. Those who consciously come to terms with the consequences of the disease often have other options open to them. The men concerned can also talk to their partners about artificial insemination, adoption or foster parenthood.
You can do that yourself
In most cases, this diagnosis is made by the fertility doctor, because patients with posttesticular hypogonadism often have no other symptoms. The first indication of the disease is unwanted childlessness. If an infection is the underlying cause of posttesticular hypogonadism, it can be treated medically. Surgical interventions and/or hormone substitutions may also lead to the seminal ducts becoming free again and the sperm becoming mobile. Some doctors also recommend taking zinc to increase sperm motility. Even a healthy, vitamin-rich diet can help the sperm duct obstruction break down naturally.
However, the patient often has to come to terms with his fertility and may have to find other ways of becoming a father. This can be artificial insemination but also adoption or taking in a foster child. To this end, the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth has set up an information portal (www.informationsportal-kinder Wunsch.de) which, among other things, provides information about advice centers in the vicinity of those affected. The association “Wunschkind” (www. Wunschkind.de) also provides independent information and coordinates self-help groups.
Discussing things openly with your partner and other people affected can prevent the feelings of shame or inferiority that could otherwise often lead to self-reproach, depression and, last but not least, to a breakup.