Infertility: The Male Factor
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Infertility: The Male Factor

It is important to clarify some questions about male infertility, which is often a misunderstood condition, and to break conventional thinking that prevents couples from getting the help that they need. 

Infertility affects about one in six couples trying to conceive. In simple terms, infertility means the failure of a couple to conceive after trying to do so for at least one full year of unprotected sex. 

When couples are not able to have babies, traditional attitudes tend to point the blame towards the woman even though the problem can result from a combination of issues, including male infertility. It is important to clarify some questions about male infertility, which is often a misunderstood condition, and to break conventional thinking that prevents couples from getting the help that they need. 

First, let’s start with the usual causes

Male infertility can be due to a low sperm count, abnormal sperm production, a blockade in the spermatic cord, chronic health conditions or trauma/injuries to the testicles. The reasons for these can include congenital or inherited medical conditions, varicocele (swollen testicular veins) which warms the testicles with its dilated veins, chronic infection to the testicles or spermatic cord, various ejaculatory issues due to spinal cord problems, medications, and surgery. Other causes include anti-sperm antibody production which mistakenly identifies the sperm as harmful invaders, testicular cancers, and its related treatments such as chemotherapy, undescended testicles with underdeveloped structure and function, hormonal imbalance, as well as problems with sexual dysfunction caused by erectile dysfunction, painful sexual intercourse, and psychological issues.

Many men are also oblivious to environmental risk factors such as overheating the testicles, for example, by wearing tight clothing or through frequent visits to the sauna/steam room and impairing sperm production in the process. Constant exposure to certain chemicals and materials such as lead, heavy metals, pesticides, and painting materials as well as to radiation may also contribute to low sperm counts. Apart from that, drugs, smoking and alcohol abuse as well as obesity caused by poor diets and inactivity may also result in infertility.

How do we tackle this condition? 

First and foremost, we need to identify the causes and establish the risk factors such as those mentioned above. Apart from general physical examinations, men need to undergo several investigations such as hormone blood tests, ultrasound to diagnose varicocele or cancer and semen analysis.

Semen analysis should be able to give a good account of sperm count, motility, morphology, and the presence of pus cells, among others, to help determine the viability and vitality of the sperm. If no sperm is found, the likelihood of the obstruction of the vas can be established. A semen analysis will help determine whether there is a need to pursue testicular biopsy for artificial insemination, like in the case of complete vas obstruction with no sperm or an extremely low sperm count due to testicular impairment. Testicular biopsy will also help us to affirm the diagnosis of testicular cancer which can be one of the causes for infertility.


Treating the condition can begin by simply modifying the lifestyle such as avoiding physically and mentally stressful situations, avoiding drug or alcohol abuse, and not wearing tight pants or underwear. Exercising and watching a healthy diet will often reverse the condition to a certain extent, especially when the infertility issue is not severe. It is also necessary to treat underlying medical conditions such as hyperlipidemia and diabetes, to treat any chronic infection of the genital tract, to seek help for erectile dysfunction/ejaculatory disorder, to correct hormonal disorders, to take medications to boost low sperm counts and to reverse potentially surgically correctable causes such as varicocele.

If all the above fails, the patient may consider assisted reproductive technology such as intrauterine inseminations (IUI), where sperm is placed directly into the woman’s uterus, in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) where the most super-selected promising sperm is injected directly into the egg and the resulting embryo is implanted into the uterus. This last option, a microsurgical procedure, has the best success rate as compared to the rest but is also the most expensive choice. 

A couple needs to support each other when coping with infertility - it is not a solo journey. Do not hesitate to seek professional help if you encounter infertility problems. Avoid experimenting with unapproved methods out of desperation as it can lead to more disastrous outcomes. Couples also have the option of adopting, which has proven to be a fulfilling choice for many families. 


Written by

Dr Warren Lo Hwa Loon
Consultant Urologist
Gleneagles Hospital Kuala Lumpur

This article was first published on New Straits Times on 27 September 2022*

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Warren Lo Hwa Loon
Urology Problems and Treatments
Gleneagles Hospital Kuala Lumpur

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