By Dr Wong Pak Seng
Consultant Obstetrician & Gynaecologist, Fertility Specialist, Sunfert International Fertility Centre
When a couple is unable to conceive, it is common for many cultures across the world to place the blame on the woman. However, conception requires both parties in order to happen. When a couple is unable to conceive after 12 months, it is advisable for both parties, not just the woman, to seek medical advice and testing to correctly identify the reason for the inability to conceive.
In this issue, we talk about male infertility to better understand why it happens and the treatments available:
1. Is male infertility a common cause of failure to conceive?
Yes, the male factor contributes about 40% of the causes of infertility on its own, and another 20% in combination with female factors. It is a myth that infertility is due to females only.
2. How common is the problem? Is it on the rise?
Yes, it is a common problem. It is estimated that about 30% of males have sub-optimal sperm count, while a completely normal sperm count is almost a rarity now. Of all the males who have poor sperm count, 5 % have completely zero sperm count (azoospermia). The quality of the male sperm has deteriorated over the decades.
3. What are the common reasons for this?
There are possibly many factors, but the commonest is likely to be a change in lifestyle. Modern men are more likely to smoke and drink heavily, or indulge in recreational drugs or have multiple sexual partners, all which can affect sperm quality. Stressful lifestyles may also lead to coital difficulties such as erectile dysfunction. On a broader view, the quality of sperm has deteriorated over the decades due to presence of heavy metals and pesticides in the food chain.
4. How is the condition diagnosed?
Diagnosis is extremely simple. Just get the man to produce a semen sample through self-masturbation. The semen sample is analysed, looking at sperm count, motility and abnormal sperm structure. If there is an abnormal semen parameter, the man may be examined to look for physical problems like swollen testicular veins or blocked ducts. Some men require blood tests to look for abnormal hormone levels.
5. What are the treatments available for male infertility?
Generally, improvement in lifestyle such as stopping smoking or drinking less alcohol may improve the sperm quality. There is however no oral medications that can really improve sperm count, except stimulatory hormones, if the man is found to be lacking in them. There are many herbal supplements in the market, but none of them really work very well.
Some men do actually have a physical problem, and may benefit from surgery. For eg, swollen testicular veins can be ligated.Man with zero sperm may benefit from surgical extraction of the sperm from the testicles if the problem is due to the blockage of ducts.
If the sperm count is really poor, the couple may be advised to proceed with fertility treatment. Man with borderline sperm quality may benefit from artificial insemination of the processed and concentrated sperms into the woman’s womb, a procedure called Intrauterine Insemination(IUI).
However, man with profoundly poor sperm can only benefit from test tube treatment, or Intracytoplasmic Sperm Injection (ICSI). In this treatment, a healthy sperm is injected into the egg to force fertilisation. ICSI has revolutionised the treatment for male factor infertility and has helped countless of man experience parenthood.
6. What are the main challenges in treatment?
The main challenge is probably to change the mind set of men that infertility is due to the women alone. Hence, in the past it was extremely difficult to get men to get a fertility check. Thankfully, modern men are now more forthcoming and more willing to come forward. The other challenge is that in helping men with profound male factor infertility, there is a risk of transferring the offending male gene to the male offspring, hence propagating male infertility. There is no treatment available for men with failure of sperm production (primary testicular failure) except sperm donation.
7. Generally, what are the success rates in treating male infertility?
With the advent of ICSI, the success rates of treating male infertility are extremely high. Regardless of sperm quality, pregnancy rate is about 55 to 60% in top fertility centres.
8. What can a couple do to increase treatment success rates?
Improvement of life style and avoiding smoking and alcohol will help to a certain degree. Wearing boxer shorts as undergarments may benefit by cooling the testicles. Taking anti-oxidants such as zinc, selenium and Vitamins A,C and E may help to promote the integrity of the genes of the sperm.
9. Is there any truth to the myth that certain sexual positions will increase success rates?
Sexual positions do not really affect the chance of pregnancy if the problem is with the man. However, women with retroverted uterus may benefit from a “rear entry” positon as this position encourages the cervix to immerse itself in the semen pool.
The Journey of Conception is meant as a guide to help couples achieve their dream of starting a family. We hope to be your trusted companion in your journey by providing pertinent answers to your burning questions about conception and fertility. The series is meant as a guide only and cannot replace medical attention. Please see a fertility specialist to get yourself and your spouse evaluated for an accurate diagnosis and treatment.
The content, opinion and views expressed in this scientific material are entirely those of the author and are in no way influenced by Merck Serono.