Infertility is a major concern for many couples trying to conceive, and in at least half of these cases, the issue lies with the male partner. Among these male infertility cases, 6% to 10% are linked to infections in the urogenital tract, according to a review article published in Deutsches Ärzteblatt International.
Dr. Hans-Christian Schuppe and his coauthors from Justus Liebig University in Giessen warn that the threat of permanent infertility caused by such infections is often underestimated. They argue that checking for infections and inflammation in men should be a standard part of infertility assessments.
Silent Infections Often Go Undetected
The main causes of inflammation in the male reproductive system are sexually transmitted infections (STIs) or urinary tract pathogens like Chlamydia trachomatis and Escherichia coli. In some cases, viruses that travel through the bloodstream can also reach the reproductive organs.
A key challenge in diagnosing these infections is their often silent nature. Many men show no symptoms, and the disease can quietly become chronic. Currently, there are no reliable non-invasive tests to detect these hidden infections. Diagnosing inflammation in areas like the epididymis or testes is especially difficult without using invasive procedures like testicular biopsies.
Surprisingly, studies show that 25% of men who undergo a testicular biopsy due to infertility have signs of inflammation, despite not showing any clear symptoms beforehand.
Infections Can Lead to Long-Term Damage
There is limited evidence about how chronic inflammation of the prostate (prostatitis) affects fertility. However, data is clearer when it comes to acute infections of the epididymis—a tube behind the testes that carries sperm. In 10% of men with such infections, no sperm was later found in their semen. In another 30%, the sperm count was significantly reduced.
More worryingly, 60% of men with epididymal infections also showed signs of infection in their testes. This raises the risk of testicular atrophy—a condition where the testes shrink and permanently lose their ability to produce sperm. Such damage can lead to irreversible infertility.
Treatment Helps, But Is Not Always Enough
If an infection is found in the male reproductive tract, doctors usually recommend antibiotics to remove the pathogen. However, this treatment does not always guarantee recovery of sperm quality. In some cases, even after the infection is gone, fertility may remain impaired.
Researchers believe this may be due to lasting immune reactions triggered by the infection. These immune responses can continue to harm the reproductive organs long after the initial infection has cleared.
A Call for Better Screening and Awareness
The authors of the review stress the need for improved diagnostic methods and more attention to male infections in infertility cases. Many of these infections go unnoticed because they do not cause pain or visible symptoms. By the time they are found, the damage may already be done.
As infertility continues to affect millions of couples worldwide, experts say it is vital to understand the role of hidden male infections and to ensure early and thorough testing during fertility evaluations.
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