Andrology centers in Germany, Austria, and Switzerland

Andrology centers in Germany, Austria, and Switzerland. Semen analysis, TESE, micro-TESE, varicocele surgery: process, costs and when to see a specialist.

88 andrology centers compared

According to their own information, 88 providers in Germany (65), Austria (10), and Switzerland (13) offer andrology. Sort by distance from your location and ask about costs and appointments. By city: Berlin · Munich · Zurich · Vienna · Hamburg · Stuttgart · Basel · Cologne · Frankfurt am Main · Düsseldorf · Münster · Ulm · Erlangen · Graz · Lucerne · St. Gallen.

This page covers Germany, Austria, and Switzerland.

Andrology is the medical specialty that deals with male fertility and reproductive health. According to the guideline of the European Association of Urology (EAU), about half of all couples facing infertility have a male factor involved. Even so, the male factor is often investigated too late.

An andrologist is the specialist for male fertility, comparable to the fertility specialist for women. Testing in men is much less invasive than in women and should always be one of the first steps in fertility diagnostics.

When to see an andrologist?

An examination by an andrologist is recommended in these situations:

  • No pregnancy after 12 months of unprotected intercourse: from that point on, the EAU guideline recommends evaluating both partners, and earlier evaluation makes sense if the female partner is older
  • Abnormal semen analysis: found by a primary care doctor or urologist
  • Known pre-existing conditions: undescended testicle, varicocele, testicular surgery, infections (mumps orchitis)
  • Before IVF/ICSI treatment: for optimal treatment planning
  • After cancer treatment: chemotherapy or radiation therapy can impair sperm production
  • Hormonal abnormalities: low testosterone levels, elevated FSH

Diagnosis: the semen analysis

The semen analysis is the central test of male fertility. A semen sample is analyzed in the lab according to the WHO criteria (2021):

Parameter WHO reference value
Volume ≥ 1.4 ml
Concentration ≥ 16 million sperm/ml
Total number ≥ 39 million per ejaculate
Progressive motility ≥ 30%
Total motility ≥ 42%
Morphology (normal forms) ≥ 4%

Important: A single semen analysis is only a snapshot, and the WHO values are not a sharp dividing line between fertile and infertile. If the values are abnormal, a second analysis is usually done after 8 to 12 weeks. It takes a little over three months for new sperm to mature, and short-term factors such as a feverish illness or medication can affect the values.

Common diagnoses

  • Oligozoospermia: too few sperm (below 39 million per ejaculate or below 16 million/ml)
  • Asthenozoospermia: reduced motility (under 30% progressively motile)
  • Teratozoospermia: too few normally shaped sperm (under 4%)
  • Oligoasthenoteratozoospermia (OAT): a combination of all three impairments
  • Azoospermia: no sperm in the ejaculate (11.2% of men undergoing andrological evaluation in a large analysis cited by the EAU guideline)
  • Cryptozoospermia: extremely few sperm, detectable only after centrifugation

Further diagnostic tests

Depending on the result of the semen analysis, additional tests may be useful:

  • Hormone profile: testosterone, FSH, LH, prolactin, estradiol, TSH
  • Testicular ultrasound: size, structure, blood flow, detection of a varicocele
  • DNA fragmentation test: measures damage to the DNA of sperm, relevant in cases of repeated IVF failure or miscarriages
  • Genetic tests: karyotype (for azoospermia or below 10 million sperm/ml), Y chromosome microdeletions (at 1 million sperm/ml or less), CFTR mutation analysis (if the vasa deferentia are absent)
  • Infection testing: if inflammation of the seminal tract is suspected

Treatment options

Conservative treatment

If sperm quality is mildly to moderately reduced, even simple measures can improve the values:

  • Lifestyle optimization: losing excess weight, quitting smoking, drinking less alcohol, regular exercise
  • Dietary supplements: zinc, selenium, L-carnitine, folic acid, coenzyme Q10 (benefit not conclusively proven according to the EAU guideline, most likely useful if a deficiency has been confirmed; stay within the maximum amounts)
  • Hormone therapy: for confirmed secondary hypogonadism, mainly hCG, with FSH if needed (clomiphene in men only off-label); testosterone is contraindicated when trying to conceive
  • Switching medications: certain medications and substances (such as testosterone products, anabolic steroids, opioids) can suppress sperm production
  • Treating infections: antibiotics for a confirmed bacterial infection; they can improve sperm quality

Varicocele surgery

A varicocele (a varicose vein at the testicle) is the most common treatable cause of male infertility and, according to the EAU guideline, affects almost 15% of all men but 35% to 40% of men with fertility problems.

If the varicocele can be felt and the semen analysis is abnormal, sperm values usually improve after surgery (microsurgical varicocelectomy), and the chance of pregnancy rises. The procedure is usually done on an outpatient basis under local anesthesia or brief general anesthesia. It takes up to two cycles of sperm production for the sperm values to improve. If the varicocele is visible only on ultrasound, surgery offers no benefit.

TESE (testicular sperm extraction)

In azoospermia, when there is no sperm in the ejaculate, sperm can be retrieved directly from testicular tissue:

Conventional TESE:

  • Open biopsy: small tissue samples are taken from the testicle
  • Success rate: 35% to 46% in meta-analyses (in non-obstructive azoospermia); familienplanung.de gives around 50% for TESE when sperm production is impaired
  • Outpatient procedure under local anesthesia or brief general anesthesia

Micro-TESE (microsurgical TESE):

  • Under the surgical microscope, the seminiferous tubules that are most likely to contain sperm are specifically identified
  • Success rate: 46% to 52% in meta-analyses; whether it is higher than with conventional TESE is debated
  • Less tissue loss, and bruising and scarring occur less often
  • Many centers consider it the method of choice for non-obstructive azoospermia

The sperm that are retrieved are used for fertilization via ICSI. Excess sperm can be cryopreserved.

MESA (microsurgical epididymal sperm aspiration)

In obstructive azoospermia (a blockage of the seminal tract, e.g., after a vasectomy or with congenital absence of the vasa deferentia), sperm are retrieved from the epididymis. Because sperm production in the testicle is intact, this almost always succeeds. According to the EAU guideline, one procedure is often enough for several ICSI cycles.

Costs

Semen analysis

  • Germany: To investigate infertility, statutory health insurance covers the cost in full. If you pay yourself, the lab analysis costs €23.31 to €30.31 under the German Fee Schedule for Physicians, and around €37 to €47 with a consultation; the Fertility Information Portal (Informationsportal Kinderwunsch) gives €80 to €200 including evaluation and consultation
  • Austria: usually covered by health insurance with a referral from a doctor, otherwise a private price that depends on the lab
  • Switzerland: lab analysis CHF 130.50 according to the official Analysis List (Analysenliste), plus the consultation; when ordered by a doctor, covered by mandatory basic health insurance (Grundversicherung), minus the deductible and coinsurance

TESE/micro-TESE

  • Germany: €800 to €2,000 according to familienplanung.de. For married couples, statutory health insurance can contribute half of the cost; it pays in full only before a therapy that damages germ cells, such as chemotherapy.
  • Austria: no official price information. As part of an IVF or ICSI attempt, the IVF Fund (IVF-Fonds) can co-finance MESA/TESE (the couple pays 30%).
  • Switzerland: no official price information. Basic health insurance covers TESE only for fertility preservation, such as before cancer treatment.

Varicocele surgery

  • Germany: There are no reliable average prices. When there is a medical indication, the operation counts as treatment of an illness; check with your health insurance fund in advance whether it covers the cost.

Male fertility and age

Although men can theoretically father children well into old age, fertility usually declines from around 40:

  • Declining motility and concentration: gradual but steady
  • Increasing DNA fragmentation: genetic errors in the sperm raise the risk of miscarriage
  • Higher paternal age: according to the EAU guideline, a risk factor in its own right for fertility problems

Early evaluation therefore makes sense for men of any age.

Frequently asked questions

Is a semen analysis uncomfortable?

The sample is collected by masturbation, either at the doctor's office (in a discreet room) or at home, if the sample can be brought to the lab within 30 to 60 minutes. Medically, the test is completely painless.

Can exercise improve sperm quality?

According to a meta-analysis, regular physical activity has a positive effect, and this applies to moderate as well as more intense recreational activity. The use of anabolic steroids, by contrast, clearly worsens the values: steroids and externally administered testosterone products strongly suppress the body's own sperm production, all the way to a complete halt.

How quickly do sperm values improve after treatment?

It takes a little over three months for new sperm to mature. Improvements from lifestyle changes, medication, or surgery therefore show up after 3 months at the earliest, and often only after 6 months.

When to go straight to ICSI instead of conservative treatment?

In severe OAT or azoospermia, when the female partner is of advanced age (time factor), or when the cause cannot be treated. Your andrologist and fertility specialist will advise together on which path makes the most sense for your situation.

Sources

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