THE birth of a child brings great joy to the whole family so when a couple struggle to conceive, it becomes a period of tremendous stress and anxiety in their marriage.
Most of the time the focus is on the woman and her inability to get pregnant.
Well meaning but at times insensitive remarks and advice often come her way.
The focus is rarely on the husband when infertility plagues a couple.
Time and time again, reports highlight couples who have struggled and overcome their infertility. However, the story is always about the woman and how she achieved her dream of motherhood through fertility treatment.
Only occasionally is there a mention of male partners in these stories.
Yet, male infertility is estimated to be as high as 50 per cent. In other words, infertility occurs in equal measures among men and women.
Despite this, public awareness of male infertility is dismally low says Sunway Medical Centre consultant fertility specialist and gynaecologist and obstetrician, Dr Kannappan Palaniappan.
Data by the National Population and Family Development Board (LPPKN) shows that 95 per cent of men who have normal sexual intercourse are not aware that they may have infertility.
A majority of men view male infertility as rare and this, coupled with their reluctance to discuss their emotions, makes it all the more difficult to provide support that could be helpful.
In most circumstances, men learn to cope by hiding their feelings and such denial leads to them failing to seek medical treatment.
Unlike women who may talk about such issues with their girlfriends, mothers or sisters, men are less likely to discuss such matters with their male friends or family members. This further hampers efforts to get them treatment.
"Men tend to have a greater negative attitude towards counselling and this makes it harder for them to attend counselling compared to women," says Dr Kannappan.
Cultural norms often make men ashamed to discuss such intimate issues.
They may feel embarrassed and assume people would judge them as not being masculine enough to father a child.
THE MALE FACTOR
According to LPPKN, the fertility level among men below the age of 30 has decreased by 15 per cent and 60 per cent of sperm analysis test results are abnormal, according to data compiled from 2010 to 2019.
Dr Kannappan says a sperm concentration of below 15 million/ml is considered low sperm count, while sperm motility below 32 per cent indicates slow moving sperm.
Also, sperm morphology below 4 per cent shows more abnormal than normal sperm.
He adds that he too has observed an increase in abnormal results in semen tests at Sunway Medical Centre in the last five years.
Abnormal semen results were detected in 53-60 per cent of infertile couples.
This means only 40-45 per cent of men have normal parameters as defined by the World Health Organisation.
The Malaysian Population and Family Survey shows that infertility among married couples has increased from 6.9 per cent in 2004 to 8.6 per cent in 2014.
This is expected to rise to 10-12 per cent which is near to the global rate of 10-15 per cent.
What does this entail for the country? Dr Kannappan says this needs to be addressed as a less fertile population means a long term issue with manpower in the country.
This can be addressed by creating more awareness of male infertility.
Medical bodies and the Ministry of Health should make more information available on male infertility and increase the presence of male counsellors.
The increase of infertility also means an increase in the number of couples seeking treatment and therefore, more regulatory bodies are needed to ensure compliance with medical ethics and treatment.
"Treatment for men is limited. It mainly consists of modifying one's lifestyle that includes regular exercise, losing weight, quitting smoking and recreational drugs, avoiding body building drugs, and reducing stress."
In most circumstances, it is not possible to completely cure male infertility but improvement can be seen with lifestyle modifications and consumption of appropriate supplements
However, when a significant male factor is present then fertility treatment in the form of IVF or ICSI is required.
"At times even this is not possible especially in the absence of sperm and adoption may be the final option."