At least a third of infertility issues are men related. Learn the reasons for male infertility and the treatments available.

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Infertility, or a failure to conceive after six months (for couples over age 35) to a year of trying is often believed to be a woman’s problem.


Health conditions in women like endometriosis or polycystic ovary syndrome are often the main causes.


However, the truth is that male infertility is at the root at least a third of the time and it’s more common than most people think.


Spelling out the facts, Dr Ronny Tan, a specialist urologist at Mount Elizabeth Medical Centre (Orchard), states, “Some 8 to 12 per cent of reproductive-aged couples worldwide suffer from infertility, and 30 to 50 per cent of cases are due to male factors.”


Based on surveys of the general population in international studies, the prevalence of male subfertility^ ranges from 10 to 15 per cent as well, he adds.


Dr Tan points out that for a man to be fertile, he needs to have a penile erection sufficiently hard for penetrative vaginal intercourse, the ability to ejaculate in the vaginal canal and sufficient sperm of good quality. “Any man who has a problem fulfilling any of these requirements would be a subfertile male.”


We list possible causes of male infertility, as well as suggested treatments.


^ The possibility of conceiving naturally, but will take longer than average.

1. Erectile dysfunction


What: Erectile dysfunction is the inability for a man to have a hard enough erection for penetrative intercourse, explains Dr Tan. Common causes include psychological issues (e.g. stress), vasculogenic issues (affecting blood flow into the penis), nerve problems, thyroid disease and testosterone deficiency.


Fixing the problem: Erectile dysfunction is treatable, Dr Tan assures, and recommends that couples seek medical attention to rule out any endocrinological causes. Erections will be possible to achieve successful penetrative intercourse after the underlying medical problem has been treated.


Treatment of erectile dysfunction includes options like oral medications (such as Viagra, Cialis and Levitra) and intracavernosal injections (jabs into the base) of the penis. “Oral medications and injections are taken before sexual activity and would improve the blood flow into the penis, allowing for a stronger penile erection and successful penetration,” Dr Tan notes.


Another option is using vacuum erection devices to improve blood flow to the penis to enable successful penetration. Yet another alternative is low-intensity extracorporeal shockwave treatment (LiESWT). In this therapy, the penis is subjected to low-intensity shock waves, causing new blood vessels to grow, which improves the strength of erections.


“Newer studies have also shown that LiESWT treatment can result in the regeneration of damaged nerves and improve erections,” Dr Tan says.

2. Ejaculatory dysfunction


What: Some men suffer from anteportal ejaculation ― their premature ejaculation issue is so severe that they ejaculate even before penetration. At the other end of the spectrum, some men are unable to ejaculate when they have vaginal intercourse.


Fixing the problem: Treatment ranges from sexual counselling, behavioural modification to medications (either to delay ejaculation or to hasten ejaculation, depending on the problem).


“Most men would undergo a combination of the listed treatments for best results,” Dr Tan elaborates. “Do note that these medications are all prescriptive and an early visit to the doctor is advised.”

3. Varicoceles


What: Varicoceles (dilated veins that drain the testicles) is the most common cause of low-quality and -quantity sperm problem and can be corrected surgically.


Varicoceles are found in 15 to 20 per cent of men in general,” Dr Tan says.  “However, for couples who seek medical attention due to their inability to conceive, 30 per cent of men would have this problem.”


He explains that the presence of varicoceles increases the temperature of the testicles, and makes the transport of oxidants and waste products away from the testicle less efficient. As a result, the sperm produced is of poorer quality with a lower count.


Fixing the problem: “Varicoceles can be treated using microsurgical varicocelectomy by the urologist, where these dilated veins are tied off,” he explains. “This would result in improvement of the sperm quality and quantity.”

4. Azoospermia


What: The ability to ejaculate does not mean that the semen would definitely contain sperm, Dr Tan points out.


“Some men can have no sperm in their ejaculated semen at all ― a condition known as azoospermia.”


He notes that azoospermia can either be due to a transport or production issue. The former means that there is an obstruction in the sperm’s journey to the prostate. In contrast, a production issue indicates that the testicles are not producing sperm, since some men have genetic conditions that result in an inability to produce sperm.


“Every patient is different and it would be difficult to elaborate on all the conditions that can cause this issue,” Dr Tan adds.


Fixing the problem: If the urologist is able to identify the site of the sperm obstruction, the condition can potentially be corrected, he elaborates. Otherwise, the urologist can use different surgical methods to harvest a man’s sperm. In some cases, too, the specialist can also prescribe medication to improve their patient’s sperm production.

5. Obesity


What: Studies show that men who are overweight or obese have worse sperm quality than those with a healthy weight. Obesity affects the quantity of sperm produced as well. A 2012 Harvard School of Public Health study found that overweight and obese men are more likely to produce lower numbers of sperm or no sperm at all than their normal-weight peers.


In addition, being obese can cause hormonal changes that reduce fertility and lead to a decreased interest in sex. Overweight men are also more likely to have trouble getting and maintaining an erection.


Fixing the problem: If your Body Mass Index (BMI) is over 30, you’re considered obese. Diet and lifestyle changes are the best solutions for reducing weight. So, focus on modifying your diet and consuming foods that contain fertility-boosting nutrients. Get plenty of exercise, too, such as simple activities like running, swimming or jogging at least three to four times a week. Do also encourage your spouse to adopt healthy lifestyle habits, so you’ll both have the same motivation to keep at it.

6. Hypogonadism


What: This condition, also known as a testosterone deficiency (little or no male sex hormone), can either be genetic or developed later in life as a result of injury or infection. Two types exist ― primary and secondary hypogonadism. Primary hypogonadism originates from a problem in the testicles, whereas secondary hypogonadism signals a problem in the hypothalamus or pituitary gland (which signals the testicles to produce testosterone).In adult males, hypogonadism may lead to a decreased sex drive and infertility.


Fixing the problem: If hypogonadism is secondary, pituitary hormones may be administered to stimulate sperm production and restore fertility. However, if a pituitary tumour is found, surgical removal or radiation may be required.


For primary hypogonadism, there’s presently no effective treatment to restore fertility, but couples can look to assisted reproductive technology to start a family.

7. Sexually-transmitted infections


What: Sexually-transmitted infections such as gonorrhea and chlamydia may also give rise to male infertility. The genital inflammation arising from such bacterial infections can affect the production and quality of sperm. Chronic and severe cases of such infections may scar and obstruct the passage of sperm. For instance, a chlamydia infection can spread to the epididymis, the tube that carries sperm. 


Fixing the problem: Consult your doctor immediately if you notice signs of a sexually-transmitted infection, such as unusual penal discharge, pain during urination or genital lumps. Antibiotics will treat most infections quickly and effectively ― prompt treatment limits damage to the male reproductive system and significantly improves the production and transport of sperm.