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.
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.”
To learn more about men’s health, please visit https://subangjayamedicalcentre.com/
