THROUGHOUT the seven years of her marriage, Elizabeth (not her real name) faced endless questions about when she and her husband planned to start a family.
This relentless probing proved very distressing and took a toll on her marriage, which ended in divorce.
Friends and family assumed the problem lay with her. In fact, a visit to a doctor had confirmed that it was her ex-husband who had fertility issues. Elizabeth has since remarried and is now mother to a 2-year-old.
Fertility problems in a marriage can be due to either spouse, but it's women who often bear the burden (and stigma) of infertility.
The male factor in infertility certainly needs more attention, more so in Malaysia. Male infertility problems are at an alarming level locally according to sperm analysis data from the National Population and Family Development Board (LPPKN), which found that 60 per cent of those tested had abnormal results.
This directly contributes to the increase in fertility problems among married couples in the country according to Deputy Women, Family and Community Development Minister Aiman Athirah Sabu.
At the same time, the national birth rate is showing a downward trend. Data from the Statistics Department shows there were only 1.7 children per every married woman in 2021.
Gleneagles Hospital Kuala Lumpur urologist, Dr Warren Lo Hwa Loon says contrary to traditional beliefs, both men and women have fertility problems.
However, women frequently shoulder the responsibility of producing the family heir, particularly in Asia, where patriarchal cultures and male dominance are prevalent.
"More often than not, the woman will be blamed if a couple is unable to conceive for any reason."
DOWN AND OUT
Men do experience a rise in stress because of their jobs, families, or the pressure to keep up with their expectations, he says.
All these factors may lead to erectile dysfunction, which negatively impacts marital life. Stress also releases steroid hormones that adversely affect sperm quality and quantity.
"Men should face their fertility problems head-on, without blaming their partners," says Dr Lo.
Treatment can be started after appropriate evaluation and investigations. First and foremost, a thorough history, physical examination and inspection of the external genitalia are required. Testicular ultrasound or hormonal assays may be required, too.
It's also crucial to rule out any medical issues that could affect sperm production. Analysis of semen is crucial to determine its quantity, mobility and morphology.
"A healthy lifestyle that includes a good diet, weight loss and regular exercise can help with minor subfertility problems. The number of sperm can also be increased with supplements," he says.
However, if after attempting all these there's still no success, couples should consider intrauterine inseminations (IUI), in vitro fertilisation (IVF), or intracytoplasmic sperm injection (ICSI) as alternative means to conceive.
IN DENIAL
A. MENARINI Singapore Pte Ltd (Malaysia Branch) recently conducted an online survey on the general understanding and awareness of erectile dysfunction (ED) among Malaysians.
The survey shows that despite general awareness and understanding about ED, Malaysians are still hesitant about seeking professional help.
ED is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
In the 2019 National Health and Morbidity Survey, it was found that among sexually active Malaysian men aged 18 and above, 47.1 per cent had probable mild ED and 31.6 per cent had probable moderate to severe ED.
According to the A. Menarini survey, 87.9 per cent of respondents understood the meaning of ED and could identify the symptoms and causes of ED. However, 41.5 per cent responded "somewhat unlikely" when it came to seeing a health practitioner for ED.
The top three causes cited by men for their struggles with maintaining an erection are stress and anxiety (34 per cent), exhaustion (32.1 per cent) and other personal reasons (15.1 per cent).
According to the World Health Organisation (WHO), millions of people experience infertility, which has an effect on families and communities. One in every six people of reproductive age worldwide experience infertility.
Male Infertility - Common Causes
*Hormonal disorders
*Obstruction of the sperm transport system
*Primary testicular failure
*Genetic disorders
*Trauma to the testis
*Certain medications/recreational drugs and harmful behaviour, including alcohol and smoking, which impair sperm production.
*Overheating of the testis, such as wearing tight clothing or pants, and frequent visits to the sauna/ steam room.
*Medical conditions, such as metabolic syndrome (hypertension, diabetes and hypercholesterolemia) and autoimmune diseases.
*Environmental pollutants and toxins, such as pesticides, lead and certain chemicals, which can be toxic to sperm, resulting in lower sperm count and quality.
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