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When a couple remains childless after years of trying, the woman is often thought to be the cause. However, blame should be apportioned equally, as about a third of cases are due to the man, with an equal proportion attributed to female problems or to problems in both partners.
Another 10 to 15 per cent of cases have no known cause. The modern lifestyle, food, environment and late marriage may contribute to difficulty in conceiving in both men and women.
 Anecdoctal evidence suggests that male subfertility is increasing. “The impression is that sperm quality is deteriorating,” said Dr Yong Tze Tein, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH).
For that reason, it is not just the wife who will be tested when couples seek treatment at SGH’s Centre for Assisted Reproduction (CARE ), said Ms Amy Lee Shaw Ni, CARE ’s Chief Embryologist. “It is extremely important in the evaluation of subfertility to consider the couple as a unit in evaluation and treatment.”
However, in most cases, the men aren’t keen to step forward and most of the initial tests are done on the wives, she said. The good news is that this trend is slowly changing.
Should the husband be found to have, for instance, a low sperm count, reduced sperm movement, or too few sperm of normal form and shape, there are currently limited treatment options available.
Some men are amenable to hormonal treatment, while some require surgical retrieval of sperm for in vitro fertilisation (IVF).
But for a large majority of men, the cause is not known and that limits management. It could be genetic, but certain lifestyle factors like smoking can play a role.
IVF is an option in the treatment of subfertility for both men and women – but the procedure, where the woman’s egg cells are fertilised by sperm outside the body and then implanted in the womb, costs about $10,000 and success is not assured.
The possibility of conception varies greatly, depending on the age of the female partner. Pregnancy occurs in up to 40 per cent of women below 34 years of age, and less than 15 per cent of women older than 40.
Ref. V10
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