When a couple is having trouble conceiving, the ‘problem’ could lie with either of them. A couple is considered as infertile if they have not conceived after 12 months of regular, unprotected sexual intercourse.
According to Dr Yeong Cheng Toh, consultant gynecologist and reproductive endocrinologist at Virtus Fertility Centre Singapore, about 15 per cent of all couples of reproductive age have a fertility problem and will need some form of assisted reproductive technology to achieve their dream of having a child.
As fertility experts have repeatedly reminded us, age remains the single most prognostic factor in trying to conceive.
“Male infertility refers to a male’s inability to cause pregnancy in a fertile female,” explains Dr James Tan, a consultant urologist at Mount Elizabeth Medical Centre. “It accounts for 40 to 50 per cent of infertility and it affects approximately 7 per cent of all men. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.”
Male infertility is diagnosed through a semen analysis. “A semen analysis is the most basic and essential part of diagnosing male infertility, followed by sperm antibody testing and assessments to determine the DNA integrity of sperm,” says Dr Yeong.
A semen analysis enables scientists to look at:
• the number of sperm, and the volume, consistency, and the pH value of the ejaculated sample.
• the morphology (size and shape) and motility (ability to move) of sperm, both of which may impede its ability to penetrate and fertilise an egg.
• the presence of anti-sperm antibodies or white blood cells which may provide clues to the presence of infection.
Dr Yeong adds: “If these results are abnormal, the man may need to repeat the semen analysis and undertake further investigations.” These include:
• a range of hormone studies, including FSH, LH, testosterone and prolactin which helps to determine testicular function.
• a physical examination to measure the size of the testicles and to exclude cysts etc.
• an ultrasound of the genitalia to look for possible causes for abnormal sperm
tests and to see if there is a block in the testicles.
Cause And Effect on Male Fertility
“The good news is that the most common causes of male infertility are easily diagnosed, and most can be treated,” says Dr Yeong. “Despite the relative ease of assessing male fertility, men don’t often attend a fertility clinic of their own volition and can be reluctant to get tested. This is often due to the association of fertility with a man’s virility. For some men, finding out that they have a problem with their fertility can be challenging, emotionally.”
So what are the main causes of male infertility? “Male fertility problems can be caused by abnormalities in sperm numbers, motility or morphology or a combination of all the above,” says Dr Yeong. He tells us why men may have an abnormal sperm count:
• Problems in the testicles: a block in the path the sperm takes to reach the penis caused by a past infection or a vasectomy.
• Physical problems: testicular trauma or undescended testes at birth.
• Hormonal imbalances: low levels of testosterone, follicle stimulating hormone (FSH) or luteinizing hormone (LH).
• Genetic causes: where the man is born with defects of the Y chromosome.
• Medical treatment: past medical or radiation treatment can cause a low sperm count, chronic medical conditions or the ingestion of drugs for the treatment of these chronic conditions.
• Lifestyle: smoking, excessive alcohol, recreational drugs, unhealthy diet, lack of exercise, and/or being significantly overweight.
“Sperm plays an important role in determining the quality of the embryo and a successful pregnancy and healthy child,” he adds. “Sperm with low DNA integrity will contribute to a poor quality embryo and a high risk of miscarriage and recurrent miscarriage. However, the causes of many sperm problems remain unknown.”
No Physical Symptoms of Male Infertility
Male infertility is difficult to diagnose as there are usually no physical symptoms. A completely healthy man can produce poor quality sperm even though sexual intercourse, erection, and ejaculation occur without any problems.
However, there are certain medical conditions that could lead to infertility.
“Varicoceles, sexually transmitted diseases like chlamydia, absent vas deferens (the tube that connects the testes with the urethra), undescended testicles, previous hernia, or pelvic surgery can lead to infertility,” says Dr Tan. “Testosterone injections can also cause the sperm count to drop significantly.
“Also, overexposure to certain environmental elements such as heat, toxins, industrial chemicals, pesticides, organic solvents, radiation, or X-ray chemicals can reduce sperm production or sperm function.”
Thankfully, there are ways to keep sperm healthy.
“Sperm have a life cycle of 72 says so healthy lifestyle choices of a good diet, exercise, not smoking and not indulging in recreational drug use all have a positive impact on sperm health,” says Dr Yeong.
“There is no scientific evidence that wearing tight clothes or bike shorts affects the quality of your sperm. However, working in hot temperatures, or relaxing in a sauna frequently can increase testicular temperature – resulting in abnormal sperm count and quality. It’s best to avoid taking long hot baths on a regular basis.
“Also, the idea that men can father a child at any age is a myth,” he adds. “After the age of 45, men have higher rates of fertility complications as their sperm volume, motility, and morphology decline. There is also the increased likelihood of damage or breaks to the sperm DNA that may result in a negative effect on fertility.”