Health Matters is a monthly column that features expert advice from doctors and medical specialists in Singapore. Have a burning health question? Email us at magherworld@sph.com.sg with “Health Matters” in your subject header and we’ll get back to you.

Tracking your ovulation cycle, loading up on an Omega-3 diet or scheduling Netflix-and-chill sessions – if you and your partner are planning on expecting, these are some of the ways you might go about it.

But what happens if it’s taking a little longer to get pregnant? The truth is, infertility affects one in six couples in Singapore, and about 15 to 20 per cent of couples here are unable to conceive within 12 months of trying for a baby.

It’s a topic that is often discussed behind closed doors, and understandably so. But with male fertility so closely linked to the idea of virility, the challenges of conceiving are often approached from a woman’s health perspective. 

One way to engage your partner on the topic of fertility health? You might consider tapping on the expertise of a fertility specialist. 

“Addressing and normalising such discussions earlier in the journey allows underlying issues to be picked up earlier, which can result in improved outcomes and enables males to be involved in the discussion,” advises Dr Roland Chieng, medical director of Virtus Fertility Centre Singapore.

He shares an example of a 42-year-old patient, who learned that he had poor sperm morphology through a semen analysis just before his wedding.

“Previously, the couple had been having normal sexual activities before marriage with effective contraception. However, his self-esteem was badly affected after he was put through supplement therapy and had to undergo multiple semen testing to track the progress of his treatment. As a result, they were unsuccessful in conception despite having unprotected sexual intercourse over a few months after marriage. Over time, sexual intercourse did not happen anymore. 

“When he spoke to me about his issues, I recommended he underwent counselling and advised him on having frequent sexual intercourse. After his counselling sessions, he managed to resume normal sexual activities and the couple was pregnant within six months.”

Below, Dr Chieng elaborates on why male fertility is on the decline globally, and what men (and their partners) can do to improve their chances of conceiving.

Dr Roland Chieng, medical director of Virtus Fertility Centre Singapore. Photo: Veronica Tay

How do you define male infertility?

Common male fertility issues can include low or abnormal sperm production – which can lead to poor sperm concentration, shape, motility (capability of movement), or even damaged or broken DNA. 

Studies have shown that male fertility is on the decline globally. Why is this so?

At Virtus Fertility Centre Singapore, more than 60 per cent of IVF cycles were related to male infertility of which seven in 10 are a result of low sperm count and/or poor sperm quality.

This mirrors the trend globally, where men today are producing fewer sperm, and of lower quality. Studies have shown that the proportion of men with a normal total motile sperm count had declined by approximately 10 per cent over the previous 16 years. 

While this could be a result of poor lifestyle choices due to increased stress caused by factors such as economic instability and the pandemic, there has been increasing evidence to suggest that environmental toxic exposure can cause infertility. 

Substances such as BPAs in plastic bottles or parabens in personal products can be easily absorbed into the skin and body, impacting the fertility of both men and women.

In addition, air pollution and heavy metals found present in food, water and cosmetics can disrupt our hormones and cause harm to sperm health.

How can men improve their fertility in their everyday lives?

One of the best ways is to start with actively choosing a healthy lifestyle, as lifestyle factors can have a major impact on their fertility. The top five tips include:

Avoid excessive physical activities: Consider avoiding physical exercises such as cycling that will produce excessive heat in the groin.

Choose boxers instead of briefs: Avoid wearing tight pants and consider switching to boxes to avoid having a negative impact on sperm production when the temperature gets too high.

Lose excess weight: Obesity can affect sperm. Adopt an active lifestyle and lose excess weight to maintain a healthy BMI

Reduce alcohol intake: Avoid excessive drinking as heavy alcohol can reduce sperm production.

Limit exposure to chemicals and toxic materials: Avoid using plastic bottles, packaged and processed foods, as there is increasing evidence to suggest chemicals used in plastic bottles can affect fertility. Instead, consume a wide variety of fresh foods and look for alternatives to chemically loaded cleaning solutions.

One of Virtus’ laboratories located within the fertility centre, which is in the heart of Orchard Road. Photo: Veronica Tay

What are the medical treatments available for men who’ve been diagnosed with infertility?

Treatments for male infertility can include surgery to retrieve sperm, hormone medication and addressing problems with sexual intercourse. 

However, if male fertility issues continue to persist, couples can consider assisted reproductive technology such as in-vitro fertilisation (IVF).

In a “standard” IVF, the sperm and egg are put together in a petri dish and the embryologist waits for the sperm to fertilise the egg on its own. Using a technique called Intracytoplasmic Sperm Injection (ICSI), a good quality sperm is selected and directly injected into the egg to ensure fertilisation. The process requires a highly skilled embryologist to wash the semen sample and select the best sperm to be directly injected into your egg. 

However, a more advanced technique, Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) treatment, allows the laboratory to enlarge the images of sperm to over 1,200 times its actual magnification. 

By comparison, a standard ICSI treatment only offers 200 to 400 times the magnification of sperm. In IMSI, the embryologist then uses predefined sperm sizes and shape to select the most appropriate sperm to be injected into the egg.