Singapore Expat Living: Male Infertility

As long as the working apparatus is in order, most men assume themselves capable of fathering a child - and that’s a fair assumption, says obstetrician and gynaecologist DR CHRISTOPHER NG, whose fertility clinic offers help for the 15 percent of couples who experience problems in this area. In half of these couples, male infertility can be a contributing factor.

Apart from the well-known culprits alcohol, tobacco smoking and obesity, here are some other possible causes - an unlucky 13 of them:

  • Variocele, a swelling of the veins that drain the testicle that may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm.
  • Infections such as gonorrhea or mumps that can interfere with sperm production or sperm health, or cause scarring that blocks the passage of sperm.
  • Anti-sperm antibodies that mistakenly identity sperm as harmful invaders and attack them
  • Cancers and non-malignant tumours that can affect the male reproductive organs or the glands that release hormones related to reproduction
  • Undescended testicles that make decreased fertility more likely.
  • Hormone imbalances such as low testosterone, resulting from disorders of the testicles or an abnormality affecting the hypothalamus, pituitary, thyroid and adrenal glands.
  • Sperm duct defects
  • Chromosome defects(Klinefelter’s syndrome) causing abnormal development of the male reproductive organs
  • Sexual intercourse problems resulting from erectile dysfunction or premature ejaculation
  • Medications like testosterone replacement therapy, long-term anabolic steroid use and chemotherapy; they can impair sperm production
  • Previous surgeries such as vasectomy, inguinal hernia repair, scrotal or testicular surgery and prostate surgery
  • Environmental factors such as overexposure to heat, heavy metals, toxins, radiation, x-rays and chemicals, which can reduce sperm production or sperm function.

To determine the cause in a particular case, scrotal ultrasound scanning, hormonal tests and chromosomal analysis are used. Semen analysis measures the number of sperm present and looks for any abnormalities in their shape and movement, also screening for sperm infections.


Surgery can correct a varicocele or repair an obstructed vas deferens, explains Dr Ng, and vasectomy can be reversed. In cases where no sperm are present in the ejaculate, sperm can be retrieved directly from the testicles or epididymis using sperm retrieval techniques as part of the IVF procedure. Sperm infections should be treated with antibiotics. Medication and counselling can improve erectile dysfunction or premature ejaculation, as can hormone replacement therapy, while multivitamins (A, C and E), zinc and l-carnitine can improve sperm quality and motility respectively. In the end, the couple may require assisted reproductive technology treatment; various forms of this are available.

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By: Dr Christopher Ng