The Men Get It

The Men Get It

WHEN IT COMES TO INFERTILITY, THE MEN CAN GET IT AS MUCH AS WOMEN. IN SUCH CASES, THE FOCUS IS ON IMPROVING THE QUALITY OF SPERM.

When couples fail to conceive, most people automatically assume it is the woman’s fault. She is usually the first to be probed for signs of infertility, even though the problem could just as easily lie with her partner - after all, half of a baby’s genetic make-up comes from the father.

According to a local survey, the source of infertility was solely in females 39% of the time, solely in males 20% of the time, and in both men and women 26% of the time. There was no clear cause for the balance of cases. So close to half of all infertility cases in Singapore can be attributed to the man having some sort of medical problem.

Many of these men react with disbelief when told they are infertile because they have been having sexual intercourse and can achieve erection and ejaculation. Their semen also appears normal. But what they cannot tell with the naked eye is the quality of the sperm within the semen. Male infertility can also be caused by medical treatments and illnesses as well as environmental and lifestyle factors.

SPERM ANALYSIS

A man contributes half of all genetic material in the new life created through the sperm - he must be able to produce healthy sperms in order to impregnate his partner.

This long journey began in childhood. As his reproductive organs mature through puberty, not only must one of his testes be functioning, his body has to produce the right mix of hormones to signal his testes to make these sperms. The sperms then have to move into the semen via delicate tubes before they are ejaculated out of the penis.

Then, the sperms themselves must be of good quality. Here are five aspects of sperms that could be lacking in an infertile man:

Sperm count According to a 2010 criterion by the World Health Organization, a normal male’s semen should contain at least 15 million sperms per millilitre; he is judged to be subfertile if his sperm count is lower. A normal volume of semen produced at ejaculation is at least 1.5ml.

Sperm motility After semen is ejaculated, sperms have to make their way through the cervix to meet the egg in the fallopian tube. If the sperms have poor motility, they will not survive the journey. More than 50% of these sperms must be motile to be considered normal.

Sperm morphology Even the form of the sperm matters. If it is abnormally shaped, it may not be able to penetrate the outer layer of the egg. At least 4% of the sperms need to be of the correct shape and size to be deemed normal.

Non-production of sperm This usually occurs because of testicular failure or birth defects. Azoospermia occurs in about 5% of infertile men. This condition occurs either because there is an obstruction of or an absence of the vas deferens (the tube that carries sperms from the testes prior to ejaculation), or failure of sperm production. However, as there can be viable sperms in the testes, an ultrasound scan of the testes and testicular aspirate would be the diagnostic test required.

Sperm DNA integrity DNA fragmentation (DFI) in sperms has been used as a predictor of male fertility. When there is a high degree of fragmentation, successful pregnancy is less likely. When DFI is under 15%, pregnancy should be easily achieved if the woman is fertile. However, when it is above 30%, the success rate drops significantly. Hyaluronic Binding Assay (HBA) is a measure of how effective the sperms are at attaching to the egg, which is the first step towards fertilisation. An HBA score of more than 85% is considered normal, whereas lower scores imply the sperms have reduced ability in attaching to the egg.

MEDICAL CONDITIONS

If a man suffers from medical problems, all of these should be optimally controlled so that he is in the best health that he can be, as this is of utmost importance to the quality of his sperms. Sexually transmitted diseases can interfere with sperm production as well as negatively impact the partners’ fertility. Even a simple viral flu will impact the quality of the semen.

ENVIRONMENTAL FACTORS & LIFESTYLE CHOICES

Sperm production is sensitive to heat, so a man intending to have a child should avoid places with elevated temperatures, such as hot tubs and saunas. Constrictive clothing, and even working with a computer on your lap, can have adverse effects on your sperm quality.

To maintain fertility, men should minimise their exposure to radiation (X-ray), heavy metals and industrial chemicals (pesticides, herbicides, organic solvents).

They should also stick to a healthy diet and maintain a weight that’s proportional to their height, as being overweight causes hormonal changes that could interfere with fertility.

However, note that cycling or running for long periods can lead to overheating and thus reduced sperm quality.

Excessive alcohol may lead to reduction in testosterone levels as well as possibly impaired sperm production and function.

Smoking will also adversely affect both sperm count and quality, and should be reduced as much as possible.

Finally, mental and emotional stress will negatively impact the fertility journey, so it’s best to try and take everything in your stride and move forward.


Dr Ann Tan
Dr Ann Tan, PBM
Obstetrician & Gynaecologist
MBBS (S'PORE), FRCOG (LONDON),
M MED (O&G) FAM (SINGAPORE)
Dr Ann Tan is the first Singaporean to hold the Diploma of Fetal Medicine from the Fetal Medicine Foundation. She presently serves on the Women’s Health Advisory Committee at the Health Promotion Board. Dr Ann Tan was a Public Service Commission Scholar, and has won several prestigious awards in her field of specialization.
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