Dr Edwin Ong, DTAP Clinic
Infertility is suspected when a couple is unable to successfully conceive after approximately 1 year of unprotected sexual intercourse. While there are many causes of infertility in both genders, over a third of them stem from the male, primarily due to problems with sperm production or delivery.
In no particular order, here are the top 5 causes of male infertility:
1. Sperm disorders
A healthy amount of good quality sperm is necessary in order to have the best chance of conceiving. Disorders may include:
Oligospermia: Low sperm count, defined as fewer than 15 million sperm per milliliter of semen. A low sperm count drastically reduces the odds of the sperm fertilising your partner’s egg.
Azoospermia: No measurable amount of sperm is present in the semen to fertilise your partner’s egg, making natural conception impossible.
Poor motility: A large proportion of sperm are unable to swim properly or are not motile at all, increasing the risk that the sperm may not be able to reach and penetrate your partner’s egg.
Abnormal morphology: Sperm are immature or abnormally shaped, and may not live long enough to fertilise the egg.
Factors that can affect the health of sperm include:
Environmental and lifestyle factors: Smoking, excessive alcohol intake, illicit drugs or steroid use, or exposure to toxins can affect the health of your sperm.
Hormonal factors: Diseases of the pituitary gland or testosterone deficiency can affect sperm production.
Testicular infection: Especially from the mumps virus or tuberculosis (TB) during childhood.
Chronic diseases: Diseases such as kidney failure can also affect the production of sperm.
Genetic diseases: Such as cystic fibrosis or hemochromatosis which can affect sperm production or transport.
2. Erectile Dysfunction
Erectile dysfunction, better known as ED, is an inability to obtain or maintain a good erection. While ED is a fairly common problem that can happen to men at any age, it is more common from middle age onwards. ED can stem from:
Atherosclerosis (restricted blood flow due to plaque buildup)
Hormonal or pituitary gland issues
Phimosis (tight foreskin)
Benign prostatic hyperplasia (BPH) - abnormal prostate enlargement
Lifestyle factors such as smoking, heavy alcohol and/or drug use
Stress or mental health conditions such as depression and anxiety
Side effects of certain medications to treat hypertension or hair loss
Varicocele is the enlargement of veins in the testicles, caused by abnormal backflow of blood. Exactly how this condition can cause infertility is unknown, but studies suggest that it could be related to warmer temperatures from the increased blood flow, which may be suboptimal for sperm production. Approximately 16% of men may have a varicocele.
4. Retrograde Ejaculation
This condition occurs when the semen enters the bladder instead of emerging through the penis during orgasm due to the muscles of the bladder neck not tightening properly. This can happen due to previous surgery, certain medications, or nerve damage caused by medical conditions. Men with this condition may experience dry orgasms whereby very little or no semen is ejaculated from the penis. Urine may also appear cloudy after an orgasm.
5. Sexually Transmitted Diseases (STDs)
STDs such as chlamydia, gonorrhea, and Human Immunodeficiency Virus (HIV), if left untreated for a prolonged period of time, can lead to the inflammation of the epididymis or testicles, interfering with sperm production and health.
Chronic inflammation to these structures may lead to permanent scarring that blocks the passage of the sperm.
How to Test, and What Needs to be Tested?
A semen analysis test would be required from the patient in order to assess fertility. Several parameters are analysed including semen volume, pH count, sperm count, motility, and morphology. The sample can also be screened for problems such as infections.
As sperm counts often fluctuate from one sample to the next, several samples may need to be collected over a period of time to ensure a higher degree of accuracy when processing the results.
Follow up tests may include the following to determine and confirm the cause:
Ultrasound scan of the testicles: To look for presence of varicoceles or other issues in the testicles and surrounding structures.
Ultrasound scan of the seminal vesicles: To analyse the ejaculatory ducts and seminal vesicles to see if they are poorly formed or blocked.
Post-ejaculatory urine test: To look for any sperm present in the urine after ejaculation to suggest retrograde ejaculation.
Testicular biopsy: Minimally invasive procedure where a small piece of tissue is removed from the testicle and observed under the microscope. This test helps to both assess the cause of infertility as well as retrieve any viable sperm for later use in assisted reproduction.
Hormonal profile: Blood test to measure testosterone levels and other related hormones essential to sperm production.
STD screen: To check for chlamydia, gonorrhea, and other infections that may affect sperm production.
Are treatments available?
Treatment options will vary according to the cause of infertility (if any is found), and may include:
Lifestyle modification: Cessation of smoking, reducing alcohol intake, increasing exercise and having a balanced diet.
Supplements: Male fertility supplements that contain a blend of micronutrients and enzymes to support healthy sperm production
Treatment of any underlying STD; however, this may not fully restore fertility.
Hormonal medications: Required in cases where infertility is caused by too much or too little of a specific hormone.
Surgery for conditions such as:Varicoceles
Ejaculatory duct obstruction
Obstructed vas deferens
Treatment for sexual dysfunction: Medication or counselling may help to improve chances of conceiving in conditions such as ED or premature ejaculation.
Assisted Reproductive Technology (ART): Sperm is obtained through normal ejaculation, surgical extraction, or from donors. The sperm is then used in ART procedures such as in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
About Dr Edwin Ong
Dr Edwin Ong underwent extensive training across various specialties including Orthopaedic Surgery, General Medicine, General Surgery, Emergency Medicine, Ear, Nose and Throat Surgery and Plastic Surgery. He focuses on comprehensive and holistic care for Men’s health, Women’s health and other Acute & Chronic medical issues including Viscosupplementation Treatment for Knee Arthritis. He firmly believes in honest communication and works closely with his patients in order to achieve the best possible outcomes.
Established in 2005, DTAP (Dr. Tan & Partners) clinics, a pioneer of the GP plus, or “General Practice with Special Interest” model in Singapore, provides holistic and comprehensive medical care for everyone. We provide basic GP services with a key focus in HIV & STD testing and management, Men’s Health (Andrology), Women’s Health, Aesthetics, and Chronic Disease Management services. DTAP clinics are located in Singapore and Malaysia, and DTAP Express is the first clinic in Singapore with express self-testing kits for STD. “DTAP to Home” is an extension of DTAP Teleconsult and DTAP Delivery for medications, supplements and health aid services.