What is Male Infertility?
Male infertility is a condition in Singapore which a man cannot get a fertile female partner pregnant due to problems with his reproductive system. Infertility is typically the inability to conceive after one year of regular and unprotected sexual intercourse. However, infertility does not necessarily imply that a man cannot have his own child with his partner, as multiple infertility treatments can increase the chances of conception.
What are the common causes of Male Infertility in Singapore?
Male infertility can be caused by various factors that affect the production, function, or delivery of sperm. Some common causes and factors contributing to male infertility include:
- Low sperm count (oligospermia): when a man’s semen contains fewer sperm than the normal reference range (usually around 15 million sperm per millilitre or more), it can be challenging to fertilise an egg.
- Poor sperm motility (asthenospermia): sperm must swim effectively to reach and fertilise an egg. Reduced sperm motility can hinder or minimise the chances of fertilising an egg.
- Abnormal sperm morphology (teratospermia): teratospermia, also known as teratozoospermia, refers to abnormal sperm morphology or shape. Sperm with abnormal shape may have difficulty penetrating the egg, which may cause infertility.
- Ejaculation issues: problems with ejaculation, such as retrograde ejaculation (semen enters the bladder instead of being expelled through the penis) or premature ejaculation, can also affect the chances of fertility.
- Obstructive and non-obstructive azoospermia: azoospermia, also known as zero sperm count, is the absence of sperm in the ejaculate. It can be caused by an obstruction in the reproductive tract (obstructive azoospermia) or by problems with sperm production in the testes (non-obstructive azoospermia).
- Hormonal imbalances: hormonal issues like low testosterone levels can affect sperm production and quality.
- Genetic factors: genetic abnormalities, such as Klinefelter syndrome or Y-chromosome microdeletions, can impact sperm production and function.
- Varicocele: a varicocele is an enlargement of the veins within the scrotum, which can lead to overheating of the testicles and affect sperm production.
- Infections and inflammatory conditions: infections, such as sexually transmitted infections or epididymitis, can damage the reproductive system and affect fertility.
- Lifestyle factors: factors like smoking, excessive alcohol consumption, drug use, obesity, and high-stress levels can also contribute to male infertility.
What are the symptoms of Male Infertility?
In most cases, male infertility often does not have noticeable signs or symptoms. Men with infertility may not be aware of their condition until they attempt to conceive with a partner and experience difficulty. However, in some cases, subtle signs or associated conditions might indicate a fertility problem. Signs and symptoms of male infertility include:
- Difficulty conceiving: the primary sign of male infertility is the inability to conceive with a fertile female partner after one year of regular and unprotected sex.
- Erectile dysfunction: erectile dysfunction is having difficulty achieving or maintaining an erection. This may affect a man’s ability to engage in sexual intercourse, which can impact fertility.
- Low libido: reduced sexual desire or a decreased interest in sex might be linked to hormonal imbalances or other underlying issues that affect fertility.
- Pain, discomfort, or swelling: some conditions, like varicoceles (enlarged veins in the scrotum), can cause pain or discomfort in the scrotum, which may indicate infertility.
- Ejaculation issues: problems with ejaculation, such as premature ejaculation or retrograde ejaculation (where semen enters the bladder instead of exiting through the penis), can affect fertility.
- Past medical history: certain medical conditions or treatments, such as a history of testicular injury, surgery, or radiation therapy, may increase the risk of male infertility.
Who is at risk of Male Infertility in Singapore?
Male infertility can affect men of all ages and backgrounds. However, certain factors can increase the risk of fertility issues in men; these are:
- Age: while men can father children at any age, fertility declines gradually after age 50. Older men may have a higher risk of fertility issues, including declining sperm count and quality.
- Sexually transmitted infections (STIs): infections such as chlamydia and gonorrhoea can lead to scarring or blockages in the reproductive tract if left untreated, affecting fertility chances.
- Genetic factors: individuals with certain genetic conditions, such as Klinefelter syndrome, Y-chromosome microdeletions, and chromosomal abnormalities, are more at risk of infertility as these conditions can impact sperm production and function.
- Hormonal imbalances: conditions that affect hormone levels, such as hypogonadism (low testosterone) or hyperprolactinaemia (elevated prolactin levels), can affect sperm production and fertility.
- Medical history: sometimes, past surgeries, injuries, or medical conditions involving the reproductive organs or genital area can increase the risk of fertility problems.
- Sexual dysfunction: men experiencing conditions like erectile dysfunction or premature ejaculation may find it more challenging to achieve pregnancy.
- Obesity: being overweight or obese can lead to hormonal imbalances and decrease sperm quality and chances of fertility.
- Stress: chronic stress may affect sexual function and hormone levels, impacting fertility.
How is Male Infertility diagnosed in Singapore?
Male infertility is typically diagnosed through a series of medical evaluations and tests. Some of the common methods of diagnosis include:
- Medical history: your urologist will ask about your overall health, sexual history, past illnesses, injuries, surgeries, and any medications or treatments that might affect fertility.
- Physical examination: a physical exam will assess your general health and examine the genital area for any abnormalities, such as varicoceles (enlarged veins in the scrotum) or physical blockages.
- Semen analysis: the most common diagnosis method is through a semen sample to analyse sperm count, motility (movement), morphology (shape), and other sperm characteristics.
- Hormone testing: blood tests may be conducted to measure hormone levels, particularly testosterone and other hormones that play a role in sperm production.
- Ultrasound: a scrotum ultrasound may be performed to evaluate the testicles and the presence of any physical abnormalities.
- Post-ejaculation urinalysis: a post-ejaculation urinalysis can help determine if sperm enter the bladder instead of exiting through the penis (retrograde ejaculation).
- Genetic testing: in cases where there is suspicion of a genetic issue affecting fertility, genetic testing may be recommended to assess for chromosomal abnormalities or specific genetic conditions.
- Sperm antibody testing: in some cases, antibodies in the semen may affect sperm motility and function. Sperm antibody testing can identify the presence of such antibodies.
- Other diagnostic procedures: in rare cases, more specialised procedures such as a vasography (imaging of the vas deferens) may be necessary to diagnose blockages or abnormalities that can obstruct the flow of sperm.
What are the treatment options for Male Infertility in Singapore?
Treatment options for male infertility depend on the underlying cause of infertility. Here are some common treatment options for male infertility:
- Lifestyle changes: your urologist may recommend necessary lifestyle changes, such as quitting smoking, reducing alcohol intake, maintaining a healthy weight, and managing stress to improve fertility.
- Medications: medicines may also be prescribed to treat hormonal imbalances or medical conditions that affect sperm production. Hormone replacement therapy, such as testosterone replacement, may be prescribed if low hormone levels are the issue.
- Surgery: surgical procedures can correct physical blockages or abnormalities that are preventing the normal flow of sperm. For example, varicocele repair can be done to treat enlarged veins in the scrotum.
- Sperm retrieval: in obstructive azoospermia, where sperm are produced but cannot reach ejaculation due to a blockage, sperm can be retrieved from the testicles.
- Intracytoplasmic sperm injection (ICSI): a single sperm is injected directly into an egg during in vitro fertilisation (IVF).
It is essential for couples dealing with male infertility to undergo a thorough evaluation with a fertility specialist or a urologist to determine the cause and the most appropriate treatment approach.
Frequently asked questions
Yes, adopting a healthy lifestyle, avoiding excessive alcohol and tobacco use, practising safe sex to prevent STIs, and protecting the genital area from injury can help reduce the risk of male infertility.
The success rate of fertility treatments varies depending on the underlying cause and the chosen treatment method. Success rates can range from moderate to high, and a fertility specialist can provide more specific information based on individual circumstances.
If a couple has been actively trying to conceive for a year without success, it is advisable to seek a medical evaluation for both partners to identify potential fertility issues.