Tell me about... Male infertility

Q. My husband and I have been trying to have children for years, but to no avail. At first, I thought it was my fault. Then we got tested at the clinic, and it was found that my husband is infertile. Is this common?

A. Male infertility is more common than most people think and want to give credit for.

First, let us define infertility. If a couple has not conceived a child after a year or more of having frequent, unprotected sex, it's possible that one of the pair is infertile.

Up to 15 per cent of couples are infertile, and as high as half of this are due to male infertility.

What does a man need to be fertile?

Basically, he needs to produce healthy sperm. This means his reproductive organs must have formed properly during puberty.

Then at least one of his testicles must be functioning correctly, and his body must produce enough testosterone and other hormones to maintain sperm production.

Next, sperm and semen must travel out to be ejaculated through the penis. The passages here must not be blocked or scarred from any previous surgery or disease.

There needs to be enough sperm in his semen. A low sperm count is defined as fewer than 15 million sperm per millilitre of semen.

The sperm must also be functional and able to move.

Failure of any of these can result in male infertility.

How would my husband know if he has infertility?

He probably won't find out until both of you have tried very hard to have a child. There may be nothing else obvious.

However, there are some signs and symptoms that certain men may notice about themselves that might herald male infertility. Look out for:

- Problems with sexual function, such as erectile dysfunction, reduced sexual desire, difficulty ejaculating, or managing to ejaculate only small volumes of semen.

- Pain, swelling or a lump in the testicular area.

- Abnormal breast growth (gynaecomastia).

- Decreased facial or body hair.

- Recurrent respiratory tract infections.

What do all these mean?

If you have problems with sexual intercourse, it certainly will be more difficult for you to conceive.

Many health conditions can cause sexual dysfunction, including a condition called retrograde ejaculation.

Here, semen enters the bladder during orgasm instead of coming out from the tip of the penis. This can be caused by many diseases, such as diabetes, past bladder/prostate surgery, spinal conditions and spinal cord injuries.

A swelling in the testes may indicate a varicocele. This is actually a swelling of the veins that drain the testicle. It is one of the commonest causes of male infertility. When the veins swell, the temperature around the testicle increases, and that is not good for sperm.

Swelling in the testicle may also mean a tumour or a testicular infection which can block the passage of sperm.

If a man has abnormal breasts (for a man) or decreased facial and body hair, he may be having a chromosomal or hormonal problem, such as low testosterone. The sperm he produces will not be very healthy then.

There are a lot of other causes of male infertility, including certain medications like anabolic steroids (used by weightbuilders) and chemotherapy.

Is it true that certain factors from the environment can cause male infertility? I have heard that wearing underwear that is too tight can cause this.

It is true that if the temperature around the testicles is too warm, the sperm will not be too viable.

Some studies even mention that sitting in a sauna or hot tub for too long can temporarily impair sperm count.

If a man sits for long periods and works with a laptop computer on his lap for long stretches, the temperature in the scrotum may also increase.

Some industrial chemicals like lead and paint can contribute to low sperm counts in the long run, especially if you work in those types of industries.

Long-term exposure to radiation or x-ray can also cause low sperm production.

I have heard that obese people have low sperm counts. Is this true?

Obesity may lead to low sperm counts by directly impacting sperm itself, and also by causing a lot of hormonal changes within the body which will impact sperm in another way.

Other lifestyle factors that can impact sperm are:

- Drug use: anabolic steroids, cocaine, marijuana.

- Drinking too much alcohol.

- Smoking, including breathing in someone else's second hand smoke.

- Stress.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.