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

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.

Conclusion: 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.