By Tan Yi Lin
There is a saying “Time and tide wait for no man”.
It means that no one is powerful enough to stop the march of time. Time is of essence, especially for couples who are planning for a family.
Conception is a Man’s Job Too
When it comes to starting a family, it is a general misconception (no pun intended!) that the man’s job is simply to “deliver the goods”. While pregnancy and childbearing are largely seen as a woman’s roles, men play a key part in setting the wheel in motion during the pre-conception and conception stage. Thus, when conception fails to occur despite regular sexual intercourse, the couple should not assume that infertility is solely due to reproductive problems in the female. Studies have found that only a third of infertility cases are due to female problems. A third are due to problems in the male and the remaining third are due to reproductive problems in both partners.
Most infertility problems are not hereditary. Couples facing challenges in conceiving after a year of trying should approach a doctor to conduct medical examinations and investigations to find out the cause.
There are a few factors that the doctor may consider when assessing male fertility.
Generally, women aged 35 and above may find it more challenging to conceive. When it comes to male fertility, studies have shown that men aged 40 and above have significantly lower fertility rates than their younger counterparts. Testes tend to get softer and decrease in size with age. “With age, the quality of the sperm changes for the worse. As a result, the risks of miscarriage and genetic abnormalities in babies born to older couples also increase”, cautions Dr Peter Chew, a senior consultant obstetrician and gynaecologist in private practice, and Chairman of aLife, a non-profit voluntary welfare organisation that promotes family life through educating and advising on reproductive health. Furthermore, a decline in sexual drive and difficulty in achieving erections in older men may also affect chances of conception.
Men who lead stressful lifestyles may not be in the mood for regular sexual intercourse, thus lowering the chances of conception. Furthermore, if he turns to smoking and drinking to manage stress levels, such habits also have a negative effect on fertility. “Alcohol and nicotine are two of the common toxic substances that directly affect sperm production. They affect the quality and quantity of the sperm,” explains Dr Chew, “They can also affect the sexual function of the male, bringing about erectile dysfunction and decrease in sexual desire.” In addition, Dr Chew also cautions that alcohol abuse directly damages testicular cells and impairs the control centres in the brain, which in turn cause the testes and prostate gland to shrink. The frequent patronage of saunas and hot baths, as well as the wearing of tight underwear may also affect the quality and quantity of sperm. “For optimal sperm production, the testicles should be about one to two degrees cooler than the rest of the body,” shares Dr Chew.
Obesity has a negative impact on fertility. A high amount of fat deposits in obese men leads to increased oestrogen (female hormone) and reduced testosterone (male hormone) levels, which in turn suppress the production and quality of sperm. In addition, obesity is often associated with erectile dysfunction, which further reduces the chances of conception.
Infections of the testis and prostate gland as a result of mumps or sexually transmitted diseases might result in a low sperm count. Medical problems such as testicular growths and varicocele (presence of abnormal veins around the testis) may also affect sperm quantity. Dr Chew provides a detailed explanation of varicocoele and its direct impact on sperm count. “For normal sperm production, the testes require a temperature a few degrees lower than the core body temperature. This is facilitated by a network of veins that surrounds the testes and drains blood back to the heart – effectively cooling that area,” he says. “When the valves within these veins are incompetent or defective, blood accumulates and the veins expand and become dilated, forming a venous lump in the scrotum. The collection of these abnormal dilated veins is known as varicocoele.”
The pooling of blood around the area raises the temperature of the testes, resulting in poor and abnormal sperm production. Over time, such compromised circulation may result in a disruption of normal male hormone production.
Varicocoele can affect both the young and elderly men. Many patients do not have symptoms despite the fact that varicocoele accounts for about 40 to 70 percent of male infertility cases.
Male Fertility Tips
Beyond maintaining a healthy lifestyle, wearing loose underwear and taking cool showers may also help ensure good sperm quality. Certain foods and supplements may also help to enhance male fertility. “Take supplements containing vitamins A, B complex, C and E, as well as trace elements like zinc and selenium,” advises Dr Chew, “Food rich in these vitamins and trace elements include brightly coloured fruits and vegetables, such as carrots, tomatoes, spinach, broccoli, green beans, oranges, berries and nuts.”
Couples facing challenges in conceiving should approach a fertility specialist for help. Besides assessing the couple’s individual health and lifestyle habits, the doctor may conduct medical investigations, such as a sperm analysis, to pinpoint possible causes of infertility. But what should a couple do if the husband refuses to have a sperm test conducted - for fear of “losing face” should the result suggest male infertility?
“I would try to find out the real reason behind his refusal. As a doctor, I can only advise the husband that this is the basic investigation that a couple has to go through if they are keen to have a baby,” says Dr Chew, “After all, the results are confidential.”
He continues, “I would also tell him that should the first sample indicate a suboptimal result, it does not mean that he is infertile. Sperm quality and quantity fluctuate every day and there are many factors that can cause the change.”
Despite the challenges that male fertility problems pose, the presence of such problems do not necessarily spell doom for couples planning to start a family. Most of the negative factors impinging on male fertility are reversible and the man can take steps to improve sperm quality by eradicating unhealthy habits, managing his stress levels and maintaining a well-balanced diet. For more serious problems such as varicocoele, medical treatment is available. Many couples have also successfully conceived with the help of Assisted Reproductive Technology (ART) such as intrauterine insemination (IUI) or in-vitro fertilisation (IVF).
I Love Children would like to thank Dr Peter Chew for his professional input.