I have been in the field of women’s health for more than two decades.
During this time, I have witnessed significant advances in the care of subfertile couples.
Yet one pattern remains unchanged: women are often blamed if a couple faces difficulties conceiving.
I believe in 2026, this mindset must change.
Half of infertility or subfertility cases are caused by male factors.
This is not a new medical fact, yet as a society, we often fail to acknowledge it.
In my clinic, I see more and more younger men presenting with issues in sperm quantity and quality.
Alarmingly, a significant proportion of male infertility is diagnosed late in the couple’s fertility journey, reflecting the common belief that infertility is primarily a female problem.
I want to stress that fertility is a couple’s issue, not a gendered problem.
This article is not about blaming anyone, but about creating awareness and encouraging meaningful action.
What is male infertility?
In simple terms, male infertility is the difficulty in achieving pregnancy due to sperm-related factors.
The most basic way to detect this is through a semen analysis – a simple laboratory test that provides vital information about sperm quantity and quality.
A semen analysis measures:
- Sperm concentration – the number of sperm per millilitre of semen
- Motility – how many sperm are alive and how well they swim
- Morphology – the percentage of sperm with normal shapes, and
- Other features – e.g. sperm agglutination, where sperm clump together, which can impair fertilisation.
For reference, a normal semen analysis typically shows at least:
- 16 million sperm per millilitre
- Over 40% motile sperm with at least 32% swimming well, and
- 4% normal-shaped sperm.
Values below these ranges indicate reduced natural conception chances, and couples may require fertility treatments to overcome sperm-related issues.
However, in my experience, I have seen couples with low sperm counts or poor quality sperm still achieve natural pregnancy or success with IUI (intra-uterine insemination).
That said, most men with severe infertility often require IVF (in-vitro fertilisation) to achieve pregnancy.
Even healthy-looking men with normal sexual function may face infertility.
Only a semen analysis can confirm the facts.
Malaysia’s current situation
Worldwide trends are reflected in Malaysia’s declining fertility, i.e. more men of younger age suffering from low sperm count and poor sperm quality.
Although lifestyle choices play a part, many men have no apparent cause for these issues.
Women are also not the only ones experiencing delayed marriage and family planning, men are too.
Male sperm quality begins to decline after the age of 25, leading to more DNA-damaged sperms and lower likelihood of pregnancy.
The diagnosis of male infertility is often made late.
I feel this is because infertility is often perceived as a woman’s problem.
Male infertility is also symptomless, which makes it more difficult to identify.
A healthy sexual life does not mean that men do not have any fertility issues.
Fear and societal expectations are also two other main factors why men usually delay doing their fertility test.
Men tend to associate masculinity with fertility, which leads to unnecessary delays in undergoing fertility tests.
Important time and fertility potential will have frequently been wasted by the time men are finally evaluated.
Semen analysis should be done earlier, not later.
The role of lifestyle
While many cases of male fertility have unknown causes, lifestyle decisions certainly play an important part in declining fertility.
Vaping and smoking harm sperm DNA (deoxyribonucleic acid), and too much alcohol consumption alters hormones.
Poor sleep, combined with long-term stress, lowers testosterone, which in turn lowers sperm count and mobility.
Sedentary lifestyles and obesity also hinder sperm production.
When testicles are overheated, sperm production may be decreased.
Heavy metals, herbicides and industrial pollutants harm sperm production and their health.
Hormones essential for the proper growth of sperm are disrupted by pollutants such as plastics.
Chronic conditions like diabetes and hypertension (high blood pressure) impact blood flow and hormone balance.
Less frequent causes of sperm production impairment include varicocele (where the veins of the scrotum are swollen), undescended testes and hormonal abnormalities.
Prostate or testicular infections can also harm sperm quality for a long time.
Improving male fertility
Male infertility directly impacts the success of any fertility treatment, especially IVF.
It also increases the risk of a miscarriage.
Improving male infertility may help to increase successful natural conception and a healthy pregnancy.
This may potentially help to avoid expensive fertility treatments.
The good news is that men can improve their fertility.
The choice is literally in their hands.
Yes, I am talking about quitting smoking and vaping, minimising alcohol consumption and eating a healthier diet.
Start exercising regularly.
Maintaining a healthy weight supports the growth of normal and functional sperm cells.
Get enough sleep as sleep patterns affect how your body’s hormones function.
Stress reduction is equally important.
Start consuming supplements rich in antioxidants such as zinc, selenium and co-enzyme Q10 (CoQ10).
Omega-3 fatty acids can help too.
Additionally, men should consume less meat and more vegetables.
Avoid supplements that contain testosterone and its derivatives.
Treat any underlying chronic illnesses such as diabetes, hypertension and thyroid disorders.
Surgical correction of grade 3 or 4 varicocele might also help.
Take home message
Fertility is a shared responsibility.
Stop the blame game and take decisive action that helps your journey towards parenthood.
Male infertility should be given similar weightage as female infertility.
Early intervention and awareness saves time and money.
Let’s acknowledge that fertility is a shared duty and that there is always hope.
So, what are you waiting for?
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
