Infertility is always one-third women’s problems, one- third men’s problems, and one-third “unknown”… We look at male fertility troubles.

We had to get to the bottom of that warning that hot laptops affect men’s fertility. So, we asked Dr Chin Chong Min, a senior consultant urologist at Mount Elizabeth Novena Hospital, if it’s true.

He says it is a misconception that placing laptops over the thigh and crotch will affect fertility. Yes, the testicles need a lower temperature (36 degrees Celsius) to function — hence the advice against hot baths, tight pants and so on. But if you are not actively trying for a baby, some heat applied to the area for a short period of time will not affect you much.

So what are the causes of infertility?

1) Genetic

Dr Chin says this refers to chromosomal defects like Klinefelter’s syndrome, Noonan’s syndrome and so on. The genetic defects are either something missing in the Y chromosome or an extra chromosome (XXY or XYY being an easy shorthand for that). The Y chromosome, being shorter than the X, is more likely to affect fertility if it has a defect.

2) Medical treatments and drugs

Dr Chin says fertility can also be affected by chemotherapy, radiotherapy, drug abuse, as well as specific medications (cimetidine for heartburn and ulcers, spironolactone for high blood pressure or heart failure, ketoconazole for fungus infections). Then, there are also the anabolic steroids, antidepressants, antihypertensives — all of which can affect your sperm production.

Your age is a factor, too: Sperm count and quality start to decline after 40

3) Varicocoeles

Another problem area — and possibly one reason that the laptop myth is so strong — is varicocoeles. Senior consultant obstetrician and gynaecologist Dr Peter Chew describes these as enlarged veins in the scrotum. They cause the temperature in the testes to rise which can affect sperm production.

4) Sperm count and quality problem

Then there is the ever-popular “low sperm count, poor sperm motility or abnormally shaped sperm”. Dr Chew says, “These can be caused by hormonal imbalances, disease or infection of testes, the prostate and other genital organs.”

Your age is a factor, too: Sperm count and quality start to decline after 40, he says. Last but not least, if a man had mumps complications , that could — in worst case scenarios — lead to shrunken testicles, abnormal sperm and other problems.



5) Erectile dysfunction/ejaculation problems

Guys may squirm when this topic comes up but erectile dysfunction of varying degrees can affect about 50 per cent of Singaporean adult males, says Dr Chew. Common causes are stress, anxiety, alcohol, drugs and chronic diseases. There are also ejaculatory problems (premature or delayed). These can be due to psychological issues, prior infections and neurological diseases, he says. Diabetes may also cause both erectile dysfunction (by affecting the health of the small blood vessels in the penis, as well as by reducing testosterone) and ejaculatory problems with the semen going “up” into the bladder, instead of out via the penis, Dr Chin says.

Things that have bad effects on fertility: Cigarettes, alcohol, being overweight, chronic illnesses, and a past history of sexually- transmitted infection.

6) Environmental and lifestyle issues

Both doctors agreed on a list of things that have bad effects on fertility: Cigarettes, alcohol, being overweight, having chronic illnesses such as diabetes, cancer, or thyroid disease, and a past history of sexually- transmitted infection such as chlamydia or gonorrhea.

Dr Chew added that there is also the “unexplained infertility”. “There may be various unidentified factors such as environmental toxins that can contribute to the low count or defective sperm function.”

How a doctor can improve male fertility

Male subfertility — not outright infertility but definitely having no luck having babies — is no rare occurrence. Dr Chin explains, “I see two to three patients a week for it. There are no known quick-fixes to improve fertility, so seek help from a urologist as soon as you can.”

The urologist will check you over and take a detailed medical history to eliminate the known causes, as listed in the previous page. He may make one or more of the following recommendations:

* Vitamins Supplements for vitamins A, C and E can be taken for months if your hormonal tests are normal.
* Stop smoking/drinking Major lifestyle changes like quitting smoking and avoiding alcohol will also boost your sperm health.
* Varicocele ligation This halts any further deterioration of sperm production, and semen quality should improve within six months. If not, it is more likely there is a simultaneous genetic defect in your sperm-producing cells. A biopsy is done on the testicles to determine the state of sperm production.
* Surgery Usually done if there is an obstruction, for example, blocked ejaculatory ducts.

Dr Chin has a final word for those wishing to start a family: “Start trying for a kid early and don’t give up!”

Dr Chin Chong Min is a senior consultant urologist at Chin Chong Min Urology and Robotic Surgery Centre, Mount Elizabeth Novena Hospital (MNH), among other duties.

Dr Peter Chew is a senior consultant obstetrician and gynaecologist at Peter Chew Clinic for Women, Gleneagles Medical Centre. He set up the non-profit voluntary welfare organisation, aLife. Dr Chew is also a board member of the voluntary group, I Love Children.

Photos: iStock

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