Infertility Affects Men Too: Overcoming the Stigma

Male infertility has emerged as a concern for many couples striving to conceive in Singapore. Despite the nation's advanced healthcare system, infertility remains a complex issue influenced by various factors.

"We are seeing an increased number of men being diagnosed with male infertility at our clinic, which could suggest a potential rise in male infertility cases in Singapore," Dr Chieng says.

What causes male infertility

Singapore's fast-paced lifestyle often involves long working hours, stress, and poor diet, leading to obesity and weight gain, which are key reasons for the cases. Others could be due to medical conditions such as hormonal imbalances or side effects of immune modulators or chemotherapy.

It could also be due to previous injury, surgery, and environmental factors, including exposure to toxins and pollutants. Importantly, male infertility can be an indicator of underlying health issues, including diabetes, cardiovascular problems, and certain cancers.

"Specific genetic predispositions such as chromosomal abnormalities and gene mutations can lead to various sperm disorders, impacting both the quantity and quality of sperm," he adds.

Men have a biological clock, too[2]. As men age, they produce less testosterone, their sperm tend to lose their ability to swim efficiently, and their structure may become increasingly irregular.

How is male infertility diagnosed?

"Even with a healthy lifestyle and fitness, it does not mean that they are producing enough good quality sperm to create a family," explains Dr Chieng.

The diagnosis starts with looking at your medical history and doing a physical exam. A key part of this diagnosis is a semen analysis, which checks several essential factors as follows related to sperm health:

• Sperm Count: A low sperm count is often a sign of infertility.
• Sperm Motility: The sperm needs to move efficiently to reach the egg. Poor motility can make fertilization difficult.
• Sperm Morphology: The shape and structure of sperm matter, too. Abnormal sperm shape can prevent successful fertilisation.
• DNA Fragmentation: Healthy sperm DNA is crucial for developing a healthy embryo. Lifestyle choices or environmental factors can cause high levels of DNA damage.

Additional tests may include checking hormone levels, genetic testing, or imaging like ultrasounds or MRIs to look for any structural abnormalities in the reproductive system.

Are there treatments for male infertility?

Hormone replacement therapy or medications could be prescribed. There are clinical procedures to correct physical blockages or abnormalities or to retrieve sperm directly from the testicles.

In the case of IVF, intracytoplasmic sperm injection (ICSI) or intracytoplasmic morphologically selected sperm injection (IMSI), a variation of ICSI that uses a higher-powered microscope to select sperm, is used with in vitro fertilization (IVF).

How to keep sperm healthy?

A simple start would be lifestyle modifications such as quitting smoking, reducing alcohol consumption, maintaining a healthy weight, and managing stress.

Maintaining a nutritious diet emphasizing fresh fruits, vegetables, and whole grains can enhance overall health. Incorporating vitamins and nutrients like vitamins C and E is essential, as these antioxidants promote sperm health. Additionally, vitamin D—found in fatty fish and eggs—can enhance semen quality and count in men while supporting higher testosterone levels and increased libido.

Heat that raises testicular temperature can result in abnormal sperm count and quality. Sitting down too long at a desk, driving, or working on your laptop on your lap creates heat. Even soaking in a hot tub or taking a sauna[3] does likewise. Maintaining a slightly lower temperature than the rest of your body helps with sperm production[4]. 

Why men don't necessarily want to treat or talk about their infertility?

The societal stigma and lack of awareness often prevent men from seeking timely help and could lead to underdiagnosis in some cases, according to Dr Chieng.

It is no surprise that in this society, men blame their partners for infertility issues, avoiding the possibility that they could be a contributing factor.

There are also challenges in getting diagnosed.

• Fear of Diagnosis: The diagnosis itself can be anxiety-provoking, leading men to delay seeking help due to the fear of bad news or potential treatment complexities.
• Denial and Avoidance: Men might deny the possibility of infertility or avoid seeking help due to the stigma mentioned above.
• Lack of Awareness: Inadequate knowledge about male infertility and its causes can prevent men from realising they might need to be checked.
• Discomfort with Testing: The semen analysis, a primary diagnostic tool, can feel embarrassing or intrusive for some men.

Keep the conversation going

Open conversations about male infertility can help break down stigma and support those affected. Men diagnosed with infertility should feel empowered to share their experiences and encourage regular check-ups.

By understanding the causes, diagnosis, and treatment options, we can address this growing concern and offer better support to individuals facing male infertility.

[1] https://www.nichd.nih.gov/health/topics/factsheets/menshealth

[2] https://www.aau.edu/research-scholarship/featured-research-topics/men-have-biological-clock-too-rutgers-study-finds

[3] https://www.uptodate.com/contents/treatment-of-male-infertility-beyond-the-basics/print#:~:text=Sitting%20in%20a%20very%20hot%20sauna%20or,problems%20in%20the%20hypothalamus%20and%20pituitary%20gland.

[4] https://my.clevelandclinic.org/health/body/scrotum