Infertility is a challenging and emotional issue for many couples trying to conceive.
According to SingHealth’s website, approximately 15% of couples in Singapore, or one in six, face difficulty conceiving after 12 months of trying for a baby.
In about 39% of these cases, the issue is related to female infertility, while 20% are due to male infertility, and 26% involve infertility issues in both partners.
Male infertility can result from a variety of issues, including low sperm count, poor sperm motility, erectile dysfunction, or problems with hormone levels. Fortunately, urologists—medical professionals who specialize in the urinary tract and male reproductive system—can play a key role in diagnosing and treating male infertility.
1. Understanding Male Infertility
Male infertility can result from problems in several areas:
Sperm production issues: Low sperm count or abnormal sperm can impair a man’s ability to father a child.
Sperm motility problems: Even if sperm are present, they may not swim well enough to reach and fertilize an egg.
Obstructions: Blockages in the reproductive tract can prevent sperm from being released during ejaculation.
Hormonal imbalances: Testosterone or other hormone deficiencies can impact sperm production and sexual function.
Erectile dysfunction or ejaculation problems: Physical or psychological issues affecting sexual performance can interfere with fertility.
2. The Role of a Urologist in Male Infertility
A urologist is an expert in male reproductive health, and they are often the first step in evaluating male infertility. When a couple is struggling to conceive, a urologist may conduct a thorough assessment to identify potential causes of infertility. This process typically includes the following:
Comprehensive Medical History and Physical Exam
A urologist will begin by gathering a detailed medical history, including any past illnesses, surgeries, or treatments that might impact fertility. They may also inquire about lifestyle factors such as smoking, alcohol use, diet, exercise, and sexual habits.
A physical exam will assess overall health, with particular attention to the genital area, where conditions like varicoceles (enlarged veins in the scrotum) or any structural abnormalities may be contributing to infertility.
Seminal Fluid Analysis (Semen Analysis)
One of the most important tests a urologist will order is a semen analysis, which evaluates sperm count, motility, and morphology (shape). This test provides key insights into the health and function of the sperm and is typically one of the first steps in diagnosing male infertility.
Hormonal Testing
In some cases, hormonal imbalances—such as low testosterone or thyroid issues—can interfere with sperm production. A urologist may order blood tests to measure hormone levels and determine if there’s an underlying hormonal issue contributing to infertility.
Genetic Testing
For some men, infertility may be linked to genetic factors. If sperm count is extremely low or absent, a urologist may recommend genetic testing to check for chromosomal abnormalities or gene mutations that affect sperm production.
Ultrasound or Imaging Tests
If a physical condition such as a varicocele or blockages in the reproductive tract is suspected, a urologist may perform ultrasound imaging to check for structural issues. In some cases, further imaging techniques like MRI or CT scans may be used to get a clearer picture.
3. Treatment Options for Male Infertility
Once the underlying cause of male infertility is determined, urologists can recommend various treatment options. The right treatment depends on the cause and severity of the infertility. Some of the most common treatments include:
Surgery for Structural Issues
For conditions like varicoceles or blockages, surgery may be necessary to correct the problem. A urologist can perform a varicocelectomy to remove or repair enlarged veins in the scrotum, or they may clear blockages in the reproductive tract to restore fertility.
Medications and Hormone Therapy
If hormonal imbalances are identified, medications or hormone therapy may be prescribed to restore normal sperm production. For example, men with low testosterone may benefit from testosterone replacement therapy or other treatments to improve sperm count.
Lifestyle Changes and Counseling
Lifestyle factors play a significant role in male fertility. A urologist may recommend changes to diet, exercise, and overall health to improve sperm quality. Smoking cessation, weight management, and avoiding excessive alcohol or drug use can all help improve fertility.
For some men, stress or psychological factors may play a role in infertility. Urologists may recommend counseling or therapy to address these issues, especially when erectile dysfunction or other performance-related issues are present.
Assisted Reproductive Technologies (ART)
If medical or surgical treatments don’t resolve the infertility, a urologist may refer the couple to a fertility specialist who can offer assisted reproductive technologies such as:
Intrauterine Insemination (IUI): Sperm is directly injected into the uterus to increase the chances of conception.
In Vitro Fertilization (IVF): Sperm is combined with an egg outside the body, and the resulting embryo is implanted in the woman’s uterus.
Intracytoplasmic Sperm Injection (ICSI): A single sperm is injected directly into an egg to facilitate fertilization.
4. Prevention and Future Fertility
While not all cases of male infertility are preventable, there are steps men can take to improve and preserve their fertility:
Avoid heat exposure: Excessive heat can negatively affect sperm production, so avoiding hot tubs or saunas is recommended.
Practice safe sex: Preventing sexually transmitted infections (STIs) can help preserve fertility.
Maintain a healthy lifestyle: A balanced diet, regular exercise, and avoiding smoking or excessive drinking can all contribute to better fertility.
Consider sperm banking: Men who are undergoing treatments (e.g., chemotherapy) that may affect their fertility should consider sperm banking to preserve sperm for future use.
5. When to See a Urologist
If you and your partner have been trying to conceive for a year or more without success (or six months if the man is over 35), it’s a good idea to see a urologist for an evaluation. A urologist can assess your fertility and, if necessary, refer you to a fertility specialist for further treatment options.
Male infertility is a complex issue, but with the help of a skilled urologist, many causes can be diagnosed and treated. Whether the issue lies in sperm production, structural problems, or hormonal imbalances, there are various treatment options available to help men overcome infertility. If you’re struggling to conceive, don’t hesitate to consult a urologist—early intervention can lead to better outcomes and give you the best chance at becoming a parent.
