Male fertility: Why the man is just as important in a fertility journey
In many couples, an unfulfilled wish to have a child is deeply felt physically, emotionally, and within the relationship. Research shows that male factors contribute to fertility problems in about 30–50% of cases. Yet in practice, the focus is still often mainly on the woman.
At Mesology Amsterdam I specialise in the male side of fertility: male fertility and subfertility, within an integrative approach for both partners.
What is male subfertility?
The World Health Organization (source: World Health Organization) defines infertility as the absence of pregnancy after 12 months of regular, unprotected intercourse. In Dutch medical practice, doctors more often use the term subfertility: reduced fertility, as long as it has not been established that pregnancy is impossible.
Male subfertility refers to a reduced ability to conceive on the male side, despite regular, unprotected intercourse. This may be related to genetic, hormonal, anatomical, lifestyle, psychological, immunological and environmental factors.
We usually distinguish between:
- Primary subfertility: a man has never fathered a pregnancy.
- Secondary subfertility: he has fathered a pregnancy in the past, but it no longer succeeds.
Subfertile does not automatically mean infertile. In many cases there are still options natural, medical and integrative.
Common causes of male subfertility
Scientific literature and clinical guidelines show that male subfertility is rarely caused by one single factor; it is usually a combination of several. The main categories are:
- Disturbances in sperm production
These are problems with the number, movement or shape of sperm cells.
Common terms include:
- Azoospermia: no sperm cells are present in the ejaculate.
- Oligozoospermia: too few sperm cells.
- Asthenozoospermia: reduced motility (movement).
- Teratozoospermia: abnormal sperm morphology (shape).
These disturbances may be linked to hormonal issues, congenital abnormalities, infections, varicocele, toxic exposure or lifestyle.
- Anatomical abnormalities
Anatomical factors interfere with the production, maturation or transport of sperm.
Examples:
- Varicocele (varicose veins around the testicle) increases scrotal temperature, causes oxidative stress and is found in a significant proportion of men with fertility problems.
- Undescended testes (cryptorchidism) in childhood increase the risk of reduced fertility later in life.
- Congenital absence or blockage of the vas deferens (the sperm ducts) prevents sperm from being transported, even though production may still be intact.
Problems around the prostate and seminal vesicles, such as prostatitis, can also affect the quality of the ejaculate and fertility.
- Hormonal and endocrine disturbances
A well‑functioning hypothalamus–pituitary–gonadal axis (HPG axis) is crucial for sperm production and testosterone balance. Disturbances may be caused by, for example:
- Hypogonadism (reduced production of sex hormones).
- Disorders of the pituitary gland (such as a prolactinoma or Cushing’s disease).
- Thyroid problems (both underactive and overactive thyroid) affecting sperm quality and hormones.
- Adrenal disorders.
- Use of anabolic steroids or testosterone therapy, which can suppress the body’s own sperm production.
- Infections and immune factors
Infections such as mumps orchitis (inflammation of the testis due to the mumps virus) can cause lasting damage to testicular tissue and sperm production. Autoimmune processes, such as anti‑sperm antibodies, may reduce sperm motility and the ability to fertilise an egg.
- Lifestyle, microbiome and environment
Lifestyle plays a major role, even though it is not always explored in depth within standard fertility care.
Important factors include:
- Smoking, alcohol, drugs and anabolic steroids – associated with poorer sperm quality and a longer time to pregnancy.
- Overweight and metabolic syndrome – disturb testosterone balance and increase low‑grade inflammation.
- Chronic stress and lack of sleep – affect cortisol, reproductive hormones and sperm production.
- Heat exposure – frequent saunas, hot baths, laptop on the lap, tight underwear raise testicular temperature.
- Endocrine‑disrupting chemicals – such as certain pesticides and plastics, can contribute to DNA damage and epigenetic changes in sperm.
- Disturbed gut and semen microbiome – can influence hormones, immune function and sperm quality.
- Unexplained subfertility
In about 25–30% of men with fertility problems, all standard tests are “normal” and no clear cause can be identified. In that case, the term unexplained subfertility is often used – an important focus area for integrative approaches.
How often is the man involved?
It is now widely recognised that male factors are the main cause in roughly 30% of fertility problems and contribute alongside female factors in another 20–30%. In other words, in about half of all couples with fertility problems, the man is part of the picture and therefore part of the solution as well.
In day‑to‑day practice, however, subfertility is still often seen as “a female issue”, which means that the man is investigated later or less extensively. That is exactly why, at Mesology Amsterdam, I include the man as a full, equal part of the fertility story from the very beginning.
Common causes of male subfertility
Scientific literature and clinical guidelines show that male subfertility is rarely caused by one single factor. It is usually a combination of several. The main categories are:
- Disturbances in sperm production
These are problems with the number, movement or shape of sperm cells.
Common terms include:
- Azoospermia: no sperm cells are present in the ejaculate.
- Oligozoospermia: too few sperm cells.
- Asthenozoospermia: reduced motility (movement).
- Teratozoospermia: abnormal sperm morphology (shape).
These disturbances may be linked to hormonal issues, congenital abnormalities, infections, varicocele, toxic exposure or lifestyle.
- Anatomical abnormalities
Anatomical factors interfere with the production, maturation or transport of sperm.
Examples:
- Varicocele (varicose veins around the testicle) increases scrotal temperature, causes oxidative stress and is found in a significant proportion of men with fertility problems.
- Undescended testes (cryptorchidism) in childhood increase the risk of reduced fertility later in life.
- Congenital absence or blockage of the vas deferens (the sperm ducts) prevents sperm from being transported, even though production may still be intact.
Problems around the prostate and seminal vesicles, such as prostatitis, can also affect the quality of the ejaculate and fertility.
- Hormonal and endocrine disturbances
A well‑functioning hypothalamus–pituitary–gonadal axis (HPG axis) is crucial for sperm production and testosterone balance. Disturbances may be caused by, for example:
- Hypogonadism (reduced production of sex hormones).
- Disorders of the pituitary gland (such as a prolactinoma or Cushing’s disease).
- Thyroid problems (both underactive and overactive thyroid) affecting sperm quality and hormones.
- Adrenal disorders.
- Use of anabolic steroids or testosterone therapy, which can suppress the body’s own sperm production.
- Infections and immune factors
Infections such as mumps orchitis (inflammation of the testis due to the mumps virus) can cause lasting damage to testicular tissue and sperm production. Autoimmune processes, such as anti‑sperm antibodies, may reduce sperm motility and the ability to fertilise an egg.
- Lifestyle, microbiome and environment
Lifestyle plays a major role, even though it is not always explored in depth within standard fertility care.
Important factors include:
- Smoking, alcohol, drugs and anabolic steroids: associated with poorer sperm quality and a longer time to pregnancy.
- Overweight and metabolic syndrome: disturb testosterone balance and increase low‑grade inflammation.
- Chronic stress and lack of sleep: affect cortisol, reproductive hormones and sperm production.
- Heat exposure: frequent saunas, hot baths, laptop on the lap, tight underwear raise testicular temperature.
- Endocrine‑disrupting chemicals: such as certain pesticides and plastics, can contribute to DNA damage and epigenetic changes in sperm.
- Disturbed gut and semen microbiome: can influence hormones, immune function and sperm quality.
- Unexplained subfertility
In about 25–30% of men with fertility problems, all standard tests are “normal” and no clear cause can be identified. In that case, the term unexplained subfertility is often used, an important focus area for integrative approaches.
The usual pathway in the Netherlands: from GP to fertility clinic
Step 1: Assessment by the General Practitioner
When a couple visits their GP with a wish to have a child, the GP usually guides them through the first year. The GP looks at how long the couple has been trying, how often they have intercourse, and at both partners’ medical history, previous infections, operations, lifestyle and medication.
For the man, the GP may perform:
- A physical examination (including testicular volume, presence of varicocele, abnormalities of penis and scrotum).
- A semen analysis (volume, pH, concentration, motility and morphology of sperm cells). Abnormal results are usually repeated.
If a pregnancy fails to occur, or if test results are clearly abnormal, the GP refers the couple to secondary care.
Step 2: Fertility clinic & specialised treatments
At the fertility clinic or with an andrologist/urologist, further tests may be done, such as:
- Hormone testing (FSH, LH, testosterone, prolactin).
- Genetic testing in cases of azoospermia or severe oligozoospermia.
- Scrotal ultrasound (for example, if varicocele is suspected).
- Sometimes sperm DNA fragmentation testing.
Depending on the findings, medical treatment options can include:
- Surgery (for example, varicocele repair or reconstruction of sperm ducts).
- Hormone therapies in specific endocrine disorders.
- Assisted reproductive techniques (IUI, IVF, ICSI).
- Sperm retrieval procedures (PESA, MESA, TESE) in different types of azoospermia.
Despite all this, the cause remains unclear in a considerable percentage of men. This is where a broader, integrative perspective can be very valuable.
What does Mesology Amsterdam do differently?
Mesology combines conventional medical knowledge with complementary approaches such as orthomolecular medicine, Ayurveda, Traditional Chinese Medicine, herbal medicine and homeopathy. Instead of looking at isolated organs or just sperm numbers, we look at the body as an interconnected whole.
In my practice in Amsterdam, a male subfertility consultation usually includes:
Comprehensive intake (90min): We discuss your fertility journey, overall health, digestion, energy, sleep, mood, libido, stress and lifestyle. If you already have test results (like semen analysis or blood tests), we integrate these.
Mesological Assessment: Using physical measurements (including testing via acupuncture points) I assess functional imbalances in organs, regulatory systems and energy. I also incorporate principles from TCM and Ayurveda to understand your constitution and resilience.
Nutrition, Microbiome and Lifestyle Analysis: We look closely at your diet, gut health, liver function, blood sugar regulation and micro‑nutrient status, because these strongly influence sperm quality and hormone balance.
Personalised Treatment Plan: You receive an individual plan with nutrition, lifestyle changes, targeted supplements, herbal support and mesological strategies aimed at optimising hormone balance, metabolism, self‑regulation and overall vitality.
Mesology is not a replacement for medical fertility care, but a complementary approach that can support your body before, during or after fertility treatments such as IUI, IVF or ICSI.
What does Mesology Amsterdam do differently?
Mesology combines conventional medical knowledge with complementary approaches such as orthomolecular medicine, Ayurveda, Traditional Chinese Medicine, herbal medicine and homeopathy. Instead of looking at isolated organs or just sperm numbers, we look at the body as an interconnected whole.
In my practice in Amsterdam, a male subfertility consultation usually includes:
Comprehensive intake (90min): We discuss your fertility journey, overall health, digestion, energy, sleep, mood, libido, stress and lifestyle. If you already have test results (like semen analysis or blood tests), we integrate these.
Mesological Assessment: Using physical measurements (including testing via acupuncture points) I assess functional imbalances in organs, regulatory systems and energy. I also incorporate principles from TCM and Ayurveda to understand your constitution and resilience.
Nutrition, Microbiome and Lifestyle Analysis: We look closely at your diet, gut health, liver function, blood sugar regulation and micro‑nutrient status, because these strongly influence sperm quality and hormone balance.
Personalised Treatment Plan: You receive an individual plan with nutrition, lifestyle changes, targeted supplements, herbal support and mesological strategies aimed at optimising hormone balance, metabolism, self‑regulation and overall vitality.
IMPORTANT: Mesology is not a replacement for medical fertility care, but a complementary approach that can support your body before, during or after fertility treatments such as IUI, IVF or ICSI.
Book your first Appointment
Would you like to know what is possible for you as a man with an unfulfilled wish to have a child?
Book an integrative fertility consultation at Mesology Amsterdam to assess your male fertility from a whole‑person perspective.
When is it useful to book an appointment?
It can be helpful to contact Mesology Amsterdam if:
- You and your partner have been trying to conceive for 12 months or longer without success.
- Your semen analysis shows abnormalities in concentration, motility or morphology.
- No clear cause has been found, but you feel there is “more” going on in your health or lifestyle.
- You are about to start or are already in a fertility trajectory and want to support your body as much as possible.
- You feel that your side of the story as a man has not really been heard or addressed yet.
For prior question don’t hesitate to contact me through my contact page.
