Male infertility


  • Ask Dr G
  • Sunday, 04 Oct 2015

The Austrian-born journalist and diplomat, Henry Grunwald - perhaps best known as the managing director for TIME magazine and the editor in chief of Time, Inc. - once described his vision of the world: “My eyes don't work, at least not fully, because they are blocked by disease. The scene around me appears though a kind of curtain, a haze.”

Lately, the coutry has been shrouded in haze. The worsening situation has forced the closure of schools, and even the cancellation of the Standard Chartered KL Marathon, as air quality deteriorated.

There was initially doubt and hesitation  but the Malaysian Athletics Federation and Institut Sukan Negara had advised the organiser to cancel the event due to health concerns.

For sure, many of the participants are profoundly disenchanted.

Amid the dismay, I am reminded of the words by Alex Steffen, the American futurist who writes and speaks about sustainability and the future of the planet.

He said: “In tough times, some of us see protecting the climate as a luxury, but that’s an out dated 20th century worldview from a time when we thought industrialization was the end goal, waste was growth, and wealth meant a thick haze of pollution.”

So are we now finally breathing in our “growth” and “wealth”?

This week, we deal with a reader who faces a haze of doubt in his life when confronting the prospect of fathering a child.

Dear Dr G,

I am writing to you as I am worried about my chances of become a Dad.

I am 36 years old and my wife is 33. We have been married for three years and have been trying for a baby for the last two years.

I am a successful lawyer and needless to say I spend a great deal of time working.

In recent years, I gained eight as I exercised less. I also have the habit of having irregular meals due to work pressure.

I drink occasionally and probably face secondhand smoking from my colleagues when we visit the bar.

I recently went to a urologist. He asked me to do a sperm count which showed oligospermia (apparently the number was slightly low).

The doctor said I have varicocele (even my scrotum suffers from varicose veins). He told me to consider an operation to improve my sperm quality.

The urologist also advised me to avoid sitting too long or wearing loose undergarments and avoid sauna and hot tubs (which I dislike, anyway!)

What are the causes of my low sperm count? Should I go for the varicose vein op?

Dave

Infertility is a common condition in modern society, and can affect up to 15% of couples, according to the World Health Organisation (WHO).

The prevalence of infertility is likely to increase with urbanisation and deferred childbearing ages.

Although the vast majority of the etiology of infertility is related to female partners, male infertility can affect up to 40% of all the causes of infertility.

Low sperm count is also known as oligospermia. Why men face declining sperm counts is shrouded with uncertainty.

Carlsen and the co-workers revealed a shocking finding that sperm count halved between 1938 and 1990.

This was also backed by another French investigation of 26,000 sperm samples in the fertility clinic between 1989 and 2005.

The study demonstrated that the average number of sperms had fallen by one third over 17 years to the low level of 50 million/ml.

Certain lifestyle changes had been advocated by researchers to improve sperm number. Although some are backed by scientific evidence, other remains urban myth at best.

Improvement of the Body Mass Index (BMI) and exercise had actually been proven to enhance the number’s game in sperms.

Food consumption with enriched anti-oxidants and stopping smoking have also been shown to support gamete growth.

Although men have been advised not to wear loose undergarments, sitting for a prolonged period, avoiding sauna and limiting the use of laptops and mobile phones, the actual scientific evidence in such practices to enhance sperm production may not be fully backed by good data.

The eradication of the varicocele of the scrotum has been under scientific scrutiny in recent years. Although most studies have the benefit of improving sperm quality, some prospective randomised controlled trials had rejected the value to increase the pregnancy rates.

However, other investigations had added to the confusion in confirming the benefit of the operation in enhancing the chances of pregnancy.

In truth, the mystery of male infertility is equally puzzling as the curtain of haze over Malaysia currently. Although there has been speculation of the source of the haze, the true impact the dust on our health, and when it is going to diminish is largely unknown.

On the other hand, the cloud of uncertainty is also hovering over the reasons behind the fall of sperm numbers and the causes of the decline. The true benefit of surgical intervention will forever remain doubtful, as long as in-depth research is carried out.

American author Ursula K Le Guin, whose work often depict futuristic alternate world in politics, natural environment and ethnography once said: “The only thing that makes life possible is the permanent, intolerable uncertainty; not knowing what comes next”.

The only thing that can be said about the haze of uncertainty in our environment and male infertility is: “That’s life!”

>The views expressed are entirely the writer’s own.

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