Infertility is often associated with women, but in
reality, male infertility contributes to about 50% of cases worldwide. In Malaysia, a study by the
National Population and Family Development Board (LPPKN) found that 60% of sperm test results were abnormal, highlighting
male infertility as a significant concern. During Men’s Health Awareness Month
(Movember), it is important to address male infertility and explore the
advancements in treatment options that offer hope to couples struggling to
conceive.
Male infertility is primarily caused by two factors, sperm production problems or blockages that prevent sperm from reaching the egg. "The most common issue I encounter is a low sperm count, often due to varicocele, an enlargement of the veins in the scrotum," says Dr Chua Ai
Chen, a Consultant in Reproductive Medicine at Subang Jaya Medical Centre
(SJMC). Varicocele affects about 40% of men with fertility problems, leading to
reduced sperm production.
Other causes of male infertility can include hormonal
imbalances, genetic conditions, and exposure to harmful environmental factors
such as pollution, chemicals, and radiation. "Lifestyle also plays a huge
role. Smoking, alcohol consumption, obesity, and even stress can impair sperm
quality," Dr Chua emphasises. Factors like poor diet, lack of exercise,
and disrupted sleep patterns can also affect fertility.
How Age and Lifestyle Impact Fertility
As men age, sperm quality naturally declines, with a
decrease in motility (movement), morphology (shape), and overall count.
Additionally, older men may experience higher rates of sperm DNA fragmentation,
which can affect embryo development and increase the risk of miscarriage.
"Age matters, but lifestyle can amplify the impact," Dr Chua warns.
Smoking, for example, introduces toxins that lead to oxidative stress and
damage sperm DNA.
Diet also plays a significant role. A healthy diet
rich in omega-3 fatty acids, antioxidants, and vitamins, like the Mediterranean
diet has been shown to improve semen quality. "Processed meats, sugary
beverages, and excessive coffee consumption, on the other hand, can worsen
sperm quality," Dr Chua adds.
Understanding Sperm Quality and Its Impact on
Fertility
For conception to occur, sperm quality plays a crucial
role. "Fertility is most likely if the semen discharged in a single
ejaculation contains at least 15 million sperm per millilitre," explains
Dr Chua. If the sperm count is too low, it can make it more difficult to
conceive, as fewer sperm are available to fertilise the egg.
In addition to sperm count, the movement or motility of
sperm is vital. Sperm must be able to swim through the cervix, uterus, and
fallopian tubes to reach the egg. "While pregnancy is possible with less
than 40% of the sperm in an ejaculation moving, 40% is considered the
threshold. The more motile the sperm, the better the chances of
conception," says Dr Chua.
Healthy sperm typically have oval heads and long tails
that allow them to swim efficiently toward the egg. Abnormal sperm shapes can
affect their ability to move properly, further reducing the chances of fertilisation.
Treatments for Male Infertility
There have been significant advancements in treating
male infertility, offering hope to many couples. For men with infections in the
reproductive tract, antibiotics are often prescribed, while steroids like
prednisolone are used when the immune system mistakenly attacks sperm. Hormonal
imbalances, such as high levels of prolactin (a condition called
hyperprolactinaemia), which affects testosterone and sperm production, can be
treated with medications like bromocriptine to help restore normal hormone
levels.
For more complex conditions like retrograde
ejaculation, where sperm goes into the bladder instead of exiting during
ejaculation, medications such as imipramine can help. Men with unexplained
infertility (where no clear cause is identified) may benefit from medications
called selective estrogen receptor modulators (SERMs), which help balance
hormones and improve fertility.
Dr Chua also highlights exciting developments in
ongoing research. "There is promising work being done on new hormone
treatments that may offer more targeted options for men with hormonal
imbalances," she says.
These advancements include new drugs that are being
studied to regulate hormones involved in sperm production. Another area of
research focuses on controlling Follicle-stimulating hormone (FSH), a key
hormone for sperm production, which may lead to more effective treatments for
infertility.
"Don't lose hope. Early intervention, a healthy lifestyle, and modern fertility treatments can make all the difference," said Dr Chua.
The Role of Female Fertility in the Equation
It is important to remember that in one-third of
infertility cases, the problem lies with the female partner. Dr Chua explains
that conditions like anovulation (failure to release eggs), endometriosis,
fibroids, or scarring from previous surgeries can impact fertility. However,
significant advancements in female fertility treatments are also improving
outcomes for many couples.
"New ovarian stimulation protocols and
preimplantation genetic testing (PGT) are major developments," Dr Chua
highlights. PGT helps in selecting embryos with the best chances of successful
implantation by screening for genetic abnormalities. Additionally, advancements
like time-lapse embryo imaging and personalised fertility treatments are
improving success rates for couples undergoing assisted reproductive
technologies like IVF.
How Modern Technologies Are Shaping Fertility
Treatment
Dr Chua is particularly excited about the role of
technology in advancing fertility care. "Intracytoplasmic Sperm Injection
(ICSI) and vitrification for egg and embryo freezing have made a big
difference," she shares. Time-lapse embryo monitoring and artificial
intelligence (AI) in embryology are revolutionising how embryologists select
the best embryos for implantation, increasing the chances of successful
pregnancies.
Additionally, ovarian tissue cryopreservation is now
offering hope for women who need to undergo treatments that may affect their
fertility, such as chemotherapy. "By freezing ovarian tissue, women can
preserve their fertility for the future," Dr Chua adds.
What Couples Should Know
For couples facing infertility, the journey can be
challenging both physically and emotionally. Dr Chua’s advice is simple,
"Seek help early. If you have been trying to conceive for over a year, or
six months if the woman is over 35, it is time to consult a fertility
specialist." Early diagnosis allows for timely intervention, improving
chances of success.
Dr Chua also stresses the importance of lifestyle
changes, such as quitting smoking, reducing alcohol intake, and maintaining a
balanced diet, as these can positively impact both male and female fertility.
"Some studies suggest that supplements like
antioxidants, including vitamin C, vitamin E, and zinc, may improve sperm
quality," she adds.
"Communication between partners is key,"
says Dr Chua. "Navigating infertility can be emotionally draining, so it
is important for couples to support each other and explore support groups or
therapy if needed."
Advancing Fertility Care at SJMC
Male infertility is a significant factor in many
couples' struggles to conceive, but advancements in both male and female
fertility treatments offer new hope. From lifestyle changes to cutting-edge
medical technologies, couples today have more options than ever to achieve
their dream of starting a family.
Dr Chua’s key message to couples is, "Don't lose
hope. Early intervention, a healthy lifestyle, and modern fertility treatments
can make all the difference."
Source:
- Parenthood
- OVA
- Utusan Malaysia
- Kelab Mama