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WHEN couples are not able to have babies, traditional attitudes tend to put the blame on women, even though it can result from a combination of issues, including male infertility.

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

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 they need.

First, let's start with the usual causes. Male infertility can be due to low sperm count, abnormal sperm production, a blockage in the spermatic cord, chronic health conditions or trauma/injuries to the testicles.

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 sexual dysfunction caused by erectile dysfunction, painful sexual intercourse and psychological issues.

Dr Lo says when couples can’t conceive, it may be due to a combination of issues, including male infertility.
Dr Lo says when couples can’t conceive, it may be due to a combination of issues, including male infertility.

THE EXTERNAL FACTORS

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 exposure to radiation may also contribute to low sperm count.

Apart from that, drugs, smoking and alcohol abuse as well as obesity caused by poor diet and inactivity, may also result in infertility.

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

Male infertility is often misunderstood and not talked about. Picture — Freepik.com
Male infertility is often misunderstood and not talked about. Picture — Freepik.com

TREATMENT

Treating the condition can begin by simply modifying one's lifestyle such as avoiding physically and mentally stressful situations, drug or alcohol abuse, and not wearing tight pants or underwear.

Exercising and keeping a healthy diet will often reverse the condition to a certain extent, especially when it 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, take medications to boost low sperm count, and reverse potentially surgically correctable causes such as varicocele.

If all the above fails, the patient may consider assisted reproductive technology such as intrauterine inseminations, where sperm is placed directly into the woman's uterus, in vitro fertilisation , or intracytoplasmic sperm injection 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 micro surgical procedure, has the best success rate compared with the rest, but is also the most expensive.

A couple need 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 could lead to disastrous outcomes.

There are many options now for couples struggling with infertility. Picture: User18526052 — Freepik.com
There are many options now for couples struggling with infertility. Picture: User18526052 — Freepik.com

UNDERSTANDING EFFEMINATE BOYS

EFFEMINATE traits among boys are generally frowned upon in Asian society as they are viewed as unnatural and even embarrassing.

Just as male infertility is rarely discussed, some families find it hard to accept what's perceived as soft behaviour in their sons. To many, it indicates a lack of masculinity.

Recently, a woman brought her teenage son to my clinic. She said he seemed to be effeminate compared with other boys in school. She had noticed these traits since he was 3 years old.

She asked if there was any medication or treatments to "cure" her son's illness (as she described it).

WHAT IS NORMAL?

For years, experts have tried to find the root causes of men developing effeminate behaviour.

One theory is that stress endured by the mother during pregnancy leads to a hormone imbalance, resulting in the alteration of the male/female hormone ratio.

Dutch neuroscientist Dick Swaab also commented that raised levels of the stress hormone cortisol during pregnancy affected the production of foetal sex hormones.

Deficient testosterone production either due to underdeveloped testicles at birth or pituitary hormone deficiency also leads to a lack of male secondary characteristics.

Environmental factors such as domineering mothers, absent fathers or male figures, growing up with female siblings, parents who raise their boys as girls and abuse by men during childhood, have also been cited as influential factors in the development of effeminate tendencies.

Raised levels of the stress hormone cortisol during pregnancy affect the production of foetal sex hormones. Picture:Valeria_Aksakova — Freepik.com
Raised levels of the stress hormone cortisol during pregnancy affect the production of foetal sex hormones. Picture:Valeria_Aksakova — Freepik.com

IS TESTOSTERONE THE ANSWER?

The mother who approached me asked about the possibility of a medical intervention for her son via testosterone injections.

My sincere and professional response was that any form of medical treatment would first require a thorough assessment of the child to identify and ascertain the root cause of the problem, if any.

There are side effects and risks to consider and parents need to be well informed about them.

There are still many questions concerning the potential impact of high-dose testosterone on long-term brain health, and how it may affect various organs. Your support and empathy as an adult could mean a lot to a child in that situation.

*The writer is a urologist at Gleneagles Hospital Kuala Lumpur.