When couples try to conceive and have not succeeded, the woman is often thought to be the cause. However, in recent years, more men are stepping forward to be assessed. This is a welcome trend as about a third of cases are due to male-related factors, a third due to female-related factors and the rest, are attributed to both.

In another 10 to 15 per cent of couples, no obvious cause may be detected. Other factors such as a modern busy lifestyle, food, environment and late age of marriage may contribute to difficulty in conceiving in both men and women.

Rising incidence of male subfertility

Anecdotal evidence suggests that male subfertility is increasing. “The impression is that sperm quality is deteriorating,” said Dr Yong Tze Tein, Senior Consultant at the Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH), a member of the SingHealth group.

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). It is extremely important to consider the couple as a unit in the evaluation and treatment of subfertility.

Should the husband be found to have, for example, no sperm, low sperm count, reduced sperm movement or too few sperm of normal form and shape, there are currently several treatment options available.

Some men are amenable to hormonal treatment, while some require surgical retrieval of sperm for in vitro fertilisation (IVF).

For a large majority of men, the cause is not clear and so treatment is not targeted to treat the sperm count but to explore ways to help the couple conceive.

In vitro fertilisation for subfertility – more couples are stepping forward and pregnancy rates are improving

IVF is an option in the treatment of subfertility in both men and women – where the woman’s egg cells are fertilised by the husband's sperm outside the body and then implanted in the womb. The success of IVF is very dependent on the age of the female partner as egg quality deteriorates with age. The pregnancy rate can be around 40 per cent in a woman below age 34 but drops significantly to less than 15 percent in a woman above 40.

As part of the Marriage and Parenthood Package announced in 2013, the Singapore government is co-funding assisted reproduction technology (ART) treatments, which include IVF. Hence, more couples are coming earlier to seek help, which is heartening because this means better pregnancy rates may be achieved since issues that can be treated are identified earlier and, if necessary, a recourse to IVF before the female age is too advanced. “Couples should not wait too long before seeking help as this would give them more options.The government grant is only for valid for females below the age of 40,” says Dr Yong.

Ref: Q15