What is infertility?

Infertility is a fairly common condition in which a man (or a woman) is unable to produce offspring. From the medical point of view, infertility is defined as the failure of a couple to conceive after one year of regular, unprotected sexual intercourse. It affects 1 in every 6 couples.

Male infertility is diagnosed when, after testing of both partners, reproductive problems have been identified in the male partner. The major cause of male infertility is failure to produce enough healthy sperm.

What causes it?

Both men and women can have problems of infertility. Studies showed that female and male factors each account for 30% of infertility cases with the rest either both suffering from problems or having non-identifiable causes.

Sperm problems are the leading causes of male infertility. Any reduction in the quantity (i.e. sperm count) or quality of sperm reduces the chances of conception. Known causes of male infertility are:

• Sperm production problems
  
  • Genetic causes such as Klinefelter Syndrome and Down Syndrome, which are associated with low sperm counts
    
  • Infections such as sexually transmitted infections and mumps may result in reduced sperm production
  
  
  • Medical conditions such as undescended testes, varicocele and torsion of testis
  
  
  • Drugs such as anabolic steroids, cancer drugs and some anti-hypertensive drugs
  
  
• Sexual problems such as erectile dysfunction, premature ejaculation and failure of ejaculation


• Hormonal causes such as pituitary tumours, though these are uncommon


• Antibodies which make sperm clump together so that they can't move properly


• Other reasons such as poor quality sperm after vasectomy reversal; spinal cord injury; and medical conditions like diabetes and hypospadias

How can I prevent it?

• Practise safer sex such as using condoms to avoid sexually transmitted diseases.


• Don’t smoke and drink in moderation.


• Avoid using anabolic steroids as they shut off sperm production.


• If you are taking any medicines, check whether they could affect sperm quality – talk to your doctor.


• Stay away from illicit drugs – one joint of cannabis can affect sperm production for 36 hours.


• Some vaginal lubricants are spermicidal or impair sperm activity.

What to do if you think you may have infertility problem

• Seek medical advice, but don't panic if your partner doesn't become pregnant straightaway – conception takes time even for the fertile couples. The usual rule of thumb is to wait a year before seeking help.
  
• Your partner also needs to be checked out because (obviously) it takes two to make a baby.


• Undergo tests as advised by your doctor, which may include:
  
  • Semen analysis
  
  
  • Sperm function tests
    
  • Blood and urine tests to check for infections
  
  
  • Hormonal blood tests – the key one measures FSH (follicle stimulating hormone), as very high levels indicate that sperm production has failed
  
  
  • Genetic tests looking for major chromosomal abnormalities
  
  
  • Testicular biopsy – a tiny sample of tissue may be extracted using a needle to find out what's happening to sperm production
  
  
  • A special X-ray to check for blockages in the vas deferens tubes and ejaculatory ducts
    

Before considering any specific treatment, make sure you are adopting healthy lifestyle such as quitting smoking and consuming alcohol sensibly. Treatments for infertility depend on the causes for it.

• Steroid treatment to reduce sperm antibody levels
  
• Antibiotics for infections
  
• Hormonal treatments
  
• Medication for some ejaculation problems
  
• Vitamins E, B12 and C, and zinc supplements may improve sperm quality
  
• Erectile dysfunction – the cause is physical in the majority of cases and can usually be successfully treated
  
• Surgical treatment for conditions such as hypospadias and varicoceles


• Assisted conception techniques such as in-vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI)
  

How can I help myself?

• Finding out that you may have some sort of fertility problem may hurt your pride. It's common to feel defective or a failure. Don't bottle up your feelings and decide that you're a failure – you're not! Try talking to your partner about how you feel – you may find that this helps both of you.


• Talking to other men in the same boat and discovering that you're not alone can also be a great help.
  
• You may seek help from fertility counseling services such as the Subfertility Service of the Family Planning Association of Hong Kong, or Assisted Reproductive Units of hospitals under the Hospital Authority or private hospitals.
 

• If all the treatments have failed, you could either accept to be childless or consider adoption. Further information can be obtained from the Adoption Unit of the Social Welfare Department at 2852-3107.

Hong Kong Family Planning Association
Service Hotline Phone: 2572 2222