ALI Zain (not his real name), 32, and his wife, married for five years, had been trying for a child from the beginning of their marriage.Though sexually active, they were yet to hear the patter of tiny feet in their house.
Ali, though frustrated, was confident that there was nothing wrong with him because he did not smoke and had been practising an active lifestyle from young. So his wife made the move to consult a doctor but the gynaecologist found there was nothing wrong with her. Ali, however,faced a different outcome when he sought medical advice.
He had bilateral varicoceles and from a seminal analysis, it was discovered that he had OAT syndrome or oligoasthenoteratozoopermia. Due to these issues, his sperm count was at only five million at the time of diagnosis. (Normal sperm count is more than 30 million per millimetre of semen.)
According to the Mayo Clinic, OAT is the most common cause of male infertility and it includes oligozoospermia (low number of sperm), asthenozoospermia (poor sperm movement) and teratozoospermia (abnormal sperm shape).
Similar to varicose vein that can occur in the leg, varicocele is an enlargement of the veins within the skin that holds the testicles (scrotum). Varicoceles are a common cause of infertility as they can cause low sperm production and reduced sperm quality.
Ali was counselled for a varicocele ligation and had a laparoscopic ligation performed. After 3 1/2 years, he still has OAT syndrome but his sperm count has increased to 25 million. Ali and his wife opted for IVF and, happily, they were successful.
Like Ali and his wife, having a baby is the desire of many married couples.But for some, this dream doesn’t become a reality or keeps getting delayed for no apparent reason. They wait and hope but always end up disappointed. Yet, other couples seem to be starting families with ease.
Infertility is an emotionally traumatic condition for a couple to face but, in most cases, the one who shoulders the worst blame is the woman who faces intrusive questioning and insensitive remarks. On top of the myths and misconceptions about infertility, women often shoulder the problem alone.
But in many cases, as with Ali, the problem can stem from the man although it’s rarely spoken of. Questioning a man about his fertility is seen as taboo while in a woman, it becomes a topic for open discussion. Dr Datesh Daneshwar, a consultant urologist at Prince Court Medical Centre, Kuala Lumpur says male infertility means that a couple cannot have a child because the man has some defects in his sperm production. It refers to a male’s inability to cause pregnancy in a fertile female.
International data suggests that males account for almost 40 to 50 per cent of infertility cases. European and Australian data suggests that in probably 20 per cent of infertility cases, the males are solely responsible.
“In other words, the incidence for both males and females is almost equal, unfortunately, females are likely to be blamed due to cultural notions and their natural child-bearing ability. “And this culture of blame needs to stop and women should not tolerate such thinking anymore,” he says.
Dr Datesh says while there is no data to support growing concerns, the rising incidence of male infertility being detected as well as the increasing numbers of male fertility clinics today imply that people are more aware about the link between men and infertility compared with the past.
This development also shows that male infertility is no longer an ego issue. More men are coming forward to seek help.
Infertility in men can result from two problems: sperm quality production and sperm delivery, says Dr Datesh.
Low count, abnormal shape and size, and non-mobile sperm can affect sperm quality. With regards to sperm delivery, male fertility can be reduced as a result of many factors including congenital abnormalities, malignancies, urogenital tract infections, endocrine disturbances, immunological factors or increased scrotal temperature (for example, as a consequence of varicocele).
“In other words, it can be anything, from a disease like prostate enlargement to an injured penis or erectile dysfunction, a common condition due to diabetes. And you’ll be surprised that some men blame women because they don’t have an erection,” he says.
However, he adds that in 30 to 40 per cent of cases, no male infertility-associated factor is found at all. Interestingly, a male with poor seminal parameters can still impregnate a very fertile female.
Can other lifestyle-related factors such as age, smoking, drinking, sitting for too long, wearing tight underwear or skinny jeans, taking up sports like cycling or horse-riding and being obese or underweight affect fertility?
Dr Datesh says there are studies linking reduced fertility to smokers, chronic alcoholics and obese men. “Any sports or activity endured over a prolonged period that increases scrotal temperature or causes injury to the reproductive system may also possibly increase the risk of infertility.”
Sperm quality will also be affected as a man ages.
PHYSICAL OR BIO-CHEMICAL
Male infertility is treatable, but may require various treatments and medications that are, inevitably, costly.
Dr Datesh says to diagnose infertility, a medical history assessment and physical examination (which includes a semen analysis) are required. A comprehensive andrological examination is also necessary if the semen analysis shows abnormalities compared with standard semen analysis.
“As for the treatment, it all depends on the factors that cause the infertility in the first place whether it’s physical or bio-chemical. Treating the varicocele, for instance, may help to improve sperm count,” he says.
In some cases, patients are advised to go for assisted fertility treatments such as in Ali’s case as it can help reduce the waiting time to start a family.
There are many types of treatment and IVF is one of the options. Although treatments are pricey, men should not let that hamper them from getting help to start a family. “Male infertility is no longer a taboo subject. Rather than blaming women, giving up or leaving it all to the Almighty, there are ways to overcome the problem,” says Dr Datesh.
Ideally, see a urologist if you and your partner are unable to conceive after a year.
Simultaneously, consult an infertility specialist who will then recommend the best options for you and your partner to start a family.
BIRTH RATE ON THE DECLINE
IN October, the Department of Statistics revealed that the country had recorded its lowest fertility rate in history.
Its Vital Statistics Malaysia 2017 report states that the crude birth rate declined from 16.7 in 2015 to 16.1 in 2016 per 1,000 population.
In addition, the total fertility rate per woman aged between 15 and 49 in 2016 was 1.9 babies, a decrease from 2.0 babies in 2015. This shows that the total fertility rate has been below the replacement level of 2.1, which also means that the average number of babies born throughout her reproductive life has been insufficient to replace herself and her partner.
These numbers are threatening as Malaysia will become an ageing nation by 2030 with increased issues concerning the elderly, such as rising health care costs.
WHO IS AT RISK
INFERTILITY in men is due to:
*Problems with sperm quality
*Problems with sperm delivery
*Wearing tight underwear/skinny jeans
*Exposure over a long duration to a hot environment
Sources: Vital Statistics Malaysia 2017 and Dr Datesh Daneshwar of Prince Court Medical Centre, Kuala Lumpur