Normozoospermic men in infertile couples: Potential benefit of early medical diagnostic procedures

Infertility, defined as the inability to achieve pregnancy despite regular, unprotected sexual intercourse for 1 year, affects approximately 15% of couples. Male factors contribute to 50% of these cases. The necessity of andrological evaluations for male partners of infertile couples with normozoospermia is currently under consideration.

From 2010 to 2020, our center evaluated 997 patients presenting with infertility and normozoospermia. All patients underwent comprehensive assessments, including physical examinations, testicular sonography, blood tests, follice-stimulating hormone beta (FSHB) c.-211 variants, and semen analyses. For comparative purposes, we established two control groups: one comprising healthy men participating in the FAMe study (n = 201) and another consisting of men seeking fertility restoration following vasectomy (n = 75). Within the infertile male group, we further stratified patients into those with primary or secondary infertility.

Analysis of patient histories revealed a significantly elevated prevalence of genital malformations (e.g., hypospadias (p = 0.024) and undescended testes during childhood (p < 0.001) in our infertile group relative to the control group. By anamnesis we could find significant more patients with erectile dysfunction (p < 0.001) in our infertile men. The physical examination showed significant more patients with obesity in our infertility group (p < 0.001). Regarding hormonal profiles, a notably higher proportion of patients in the infertility group exhibited hypogonadism (p < 0.001), while compensated hypogonadism was more common in the control group. Reduced serum follicle-stimulating hormone (FSH) concentrations in men with the FSHB c.-211 GT/TT polymorphism versus the GG wildtype were only present in the infertile but not the fertile cohort (p < 0.001). Evaluation of ejaculate samples indicated a significant increase in round cells (p < 0.001) and leukocytes (p = 0.013) in our infertile patients compared to the healthy subjects.

The assessment of men presenting with infertility and normozoospermia unveiled a marked prevalence of physical and genetic findings. This underscores the critical need for andrological evaluations to prevent potential long-term consequences.

The andrological examination of normozoospermic and infertile men promises better health outcomes for the patients as well as it aids in refining fertility treatment options for their female counterparts.