The Straits Times reported in February that Singapore’s total resident fertility rate (TFR) has fallen below 1 for the 1st time in our nation’s history. This is far from the population replacement rate of 2.1. Our low fertility should not come as a surprise as Singapore has not provided a conducive environment to start a family with a dual working family unit, intense competition, work-life imbalance and a high cost of living. South Korea retains the world’s lowest total fertility rate at 0.72 in 2024, and its policymakers face similar challenges in increasing the fertility rate.
On the other spectrum, many couples fail to conceive even if they want to. Infertility is defined as the inability to impregnate a fertile female partner (<35 years old) through regular unprotected sexual intercourse after 12 months. The cumulative conception in an average young couple is 80% by the first year and 95% by the second year. This rate drops to 80% by the second year if the female is above 35 years old. In many instances, couples spontaneously conceive after 12 months without any treatment, and thus, it is not uncommon for couples to seek treatment and evaluation after two years of trying. Male infertility issues fall under the care of Urologists, while female is taken care of by Obstetricians.
Nevertheless, it is usually the ladies who get their fertility investigated as part of assisted reproductive therapy (ART), and men only get asked to donate a semen sample with little or no investigation. Yet it takes two to clap and research shows both parties contribute to infertility about 35% of the time, and in 10% of the cases, the issue lies only with the man. IVF without investigating the men will only lead to failure in these instances.
Sperm is the male’s contribution to reproduction, and for sperm to do its job, you need to have three qualities. High-quality sperm in adequate numbers that can swim properly. In other words, low numbers (oligozoospermia) or no sperm(azoospermia), low motility (asthenospermia) or abnormal morphology (teratozoospermia) are the main issues with sperm quality. These issues can be in isolation or combination in 80% of infertile men.
There are many causes of male infertility, and it can be divided into four main areas.
Apart from having issues with sperm production, many other common reasons can affect fertility:
If you think you may be presenting symptoms of Subfertility, schedule a consult as soon as possible.
Diagnosis of the source of the problem would include a detailed medical and sexual history. Information on age, previous pregnancies, timing of the intercourse to the reproductive cycle, frequency, use of lubricants, existing medical condition and body mass index are crucial. These consults are also most fruitful if you and your partner are present. Your doctor will perform a physical examination with attention to testes size with a Prader orchidometer and the presence of any penile abnormality like phimosis, structure abnormality, and overall state of secondary sexual features. A semen analysis is a cornerstone of male infertility investigation and can assess sperm quality as described above. If required, a blood hormonal profile, scrotal ultrasound to look for abnormalities and genetic testing will be performed.
When a treatable cause is identified, many treatment options can improve your chances of conception—lifestyle modification like smoking cessation, maintaining healthy body weight, supportive underwear for varicocele and limiting toxins can be all that is necessary to improve sperm quality. Avoiding spermicidal lubricants, awareness of intercourse frequency, and attention to the female ovulation period can play a crucial role as well. Medications are available to treat erectile dysfunction and improve sperm parameters. Where necessary, your Urologist can discuss surgical intervention for varicocele repair, testicular sperm extraction (TESA) or microsurgical epididymal sperm aspiration (MESA) to retrieve sperm for assisted reproductive techniques (ART). Where sperm delivery is the problem, ART procedures like in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or intrauterine insemination (IUI) can help overcome male infertility as well.
It is essential to understand that successful conception may come easily for some couples but can be life-changingly difficult for others. If necessary, counselling and support groups may be useful for emotional support and guidance.
If you and your partner have a problem, it’s time to man up and consider seeing a Urologist to rule out issues. Your Urologist should provide a patient, empathetic listening ear to you and your wife. These consultations take a long time, but they are rewarding when we can pinpoint the problem and help a couple conceive.
If you think you may be presenting symptoms of Subfertility, schedule a consult as soon as possible.
Our friendly team is looking forward to serving you. For urgent enquiries and appointment requests, please call the clinic directly.
Dr Jay Lim is a urologist with a focus on providing personalised treatment plans specific to your unique urinary and reproductive health needs.
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