Quick answer. Infertility is common, and a male factor is involved in roughly 40-50% of couples who have trouble conceiving, so men should be assessed alongside their partner, not just the woman. The key first test is a semen analysis (checking sperm count, motility and shape/morphology), usually repeated if abnormal and supported by history, examination and sometimes hormone blood tests, scrotal ultrasound or genetic tests. Common causes include varicocele (enlarged scrotal veins and the most common correctable cause), hormonal problems, infections, a history of undescended testes, blockages, genetic factors and lifestyle factors such as smoking, heavy alcohol, obesity, heat and anabolic steroids. Treatment ranges from fixing reversible causes (e.g. varicocele repair, hormone therapy) to assisted reproduction such as IUI, IVF and ICSI, with surgical sperm retrieval where needed; see a doctor if you have not conceived after about 12 months of trying (6 months if the female partner is over 35).
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Difficulty conceiving is more common than many couples realise, and it is not only a female issue. In about 40-50% of couples who struggle to conceive, a male factor contributes, so both partners should be assessed together from the start. The good news is that male fertility can usually be investigated with simple tests, many causes are treatable, and modern assisted reproduction can help even when sperm numbers are very low. This guide explains the common causes, the tests involved, and the treatment options available in Singapore.
At a glance
| Aspect | Detail | Notes |
|---|---|---|
| Male factor frequency | Involved in about 40-50% of couples with difficulty conceiving | Both partners should be assessed together |
| Main test | Semen analysis – count, motility, morphology | Repeated if abnormal; plus history, exam, sometimes hormones, ultrasound or genetic tests |
| Most common correctable cause | Varicocele (enlarged scrotal veins) | Can be treated with varicocele repair to improve sperm quality |
| Other common causes | Hormonal problems, infections, undescended-testes history, blockages, genetic and lifestyle factors | Lifestyle changes (stop smoking, reduce alcohol, healthy weight, no steroids) can help |
| Assisted reproduction | IUI, IVF, ICSI; surgical sperm retrieval (PESA/TESA/TESE/micro-TESE) if needed | ICSI can work with very few sperm |
| When to see a doctor | After ~12 months trying (6 months if female partner is over 35) | GP first, then urologist/andrologist and/or fertility specialist |
How common is male infertility, and why assess both partners?
Infertility affects roughly one in six to one in seven couples. A male factor is found in about 40-50% of couples who have trouble conceiving, sometimes on its own and sometimes alongside a female factor. Because of this, fertility specialists recommend that the man is assessed at the same time as the woman rather than waiting until the female workup is complete.
Assessing the male partner is quick, non-invasive and often gives clear answers early. It can also pick up treatable problems and, occasionally, underlying health conditions that are worth knowing about regardless of fertility. Male infertility carries no blame and is rarely about virility or sexual performance, so a joint, supportive approach helps couples make decisions together.
The main test: semen analysis
The cornerstone of the male fertility workup is a semen analysis. After a short period of abstinence (typically 2-5 days), a sample is examined in the laboratory to assess:
- Sperm count / concentration – how many sperm are present.
- Motility – how well the sperm move.
- Morphology – the shape and structure of the sperm.
Sperm production varies over time, so an abnormal result is usually repeated after a few weeks before drawing conclusions. Alongside the semen analysis, the doctor will take a medical history and perform a physical examination (including the testes and scrotum). Depending on the findings, further tests may include hormone blood tests (such as testosterone and FSH), a scrotal ultrasound, and in selected cases genetic tests, particularly when very few or no sperm are found.
Common causes of male infertility
Male infertility has many possible causes, and several are treatable:
- Varicocele – enlarged veins in the scrotum. This is the most common correctable cause and can reduce sperm quality and quantity.
- Hormonal problems – imbalances affecting sperm production.
- Infections – some genital or reproductive-tract infections affect sperm.
- History of undescended testes – especially if corrected late in childhood.
- Blockages (obstruction) – blocked or absent ducts that carry sperm.
- Genetic factors – chromosomal or gene-related causes, more likely when sperm counts are very low or absent.
- Lifestyle and medical factors – smoking, heavy alcohol use, obesity, excessive heat, certain medications, anabolic steroids, and some chronic medical conditions.
In some men, no single cause is identified, which is why treatment is tailored to the test results and the couple’s situation.
Treatment options
Treatment depends on the cause and on the couple’s wider fertility picture.
Lifestyle changes are often the first step and can genuinely help: stop smoking, reduce alcohol, reach a healthy weight, avoid anabolic steroids, and limit excessive heat to the testes.
Treating reversible causes may include varicocele repair (for example microsurgical varicocelectomy) to improve sperm parameters, hormonal treatment where there is a hormone imbalance, and treating relevant infections.
Assisted reproduction is used when conceiving naturally is unlikely or when treating the cause is not enough:
- IUI (intra-uterine insemination) – prepared sperm is placed directly into the womb.
- IVF (in-vitro fertilisation) – eggs and sperm are combined in the laboratory.
- ICSI (intracytoplasmic sperm injection) – a single sperm is injected into an egg, useful when sperm numbers or quality are very low.
Where there is no sperm in the ejaculate (for example due to a blockage), surgical sperm retrieval techniques such as PESA, TESA, TESE or micro-TESE can recover sperm directly from the testis or epididymis for use with IVF/ICSI.
Costs, MediSave and government co-funding
In Singapore, assisted reproduction ties into national fertility support. At public Assisted Reproduction centres (at KK Women’s and Children’s Hospital, Singapore General Hospital and National University Hospital), eligible Singapore Citizen couples can receive government co-funding of up to 75% of treatment costs for IVF/ICSI and IUI, with lower percentages for citizen-PR and citizen-foreigner couples. Co-funding generally covers up to 3 fresh and 3 frozen IVF cycles and up to 3 IUI cycles, subject to eligibility and age conditions.
MediSave can also be used to help pay for assisted conception, with withdrawal limits set per cycle and a lifetime cap. Figures and eligibility are reviewed periodically, so confirm current details with MOH and your treating centre before starting treatment.
When and who to see
As a general guide, see a doctor if you and your partner have not conceived after about 12 months of regular, unprotected intercourse – or after about 6 months if the female partner is over 35, or if there are known risk factors (for example previous testicular surgery, undescended testes or low sperm tests).
A GP is a good starting point and can arrange an initial semen analysis. From there you may be referred to a urologist or andrologist for the male assessment and treatable causes, and/or to a fertility specialist who manages both partners and assisted reproduction. Wherever possible, attend as a couple so both partners can be assessed together.
Related guides
- Best Urology Clinics in Singapore — our editorial shortlist
- urology clinics directory
- Low testosterone & andropause
- Premature ejaculation treatment
- Testicular lumps & pain
Sources
- SGH – Infertility can be a man's problem too
- NUH – Services for Subfertility (Male)
- MOH – Marriage and Parenthood Schemes (assisted conception co-funding and MediSave)
- MOH – New Co-funding Scheme and Extension of MediSave Coverage
- Made For Families – Co-Funding for Assisted Conception Procedures
See also
Related conditions & guides
Related conditions and guides you may find useful:
- Blood in Urine (Haematuria) in Singapore
- Enlarged Prostate (BPH) & PSA Screening in Singapore
- Erectile Dysfunction (ED) Treatment in Singapore
- Kidney Stones Treatment in Singapore
- Overactive Bladder & Urge Incontinence in Singapore
- Prostate Cancer in Singapore
Find a specialist
Prefer a named doctor? See our independent, sub-specialty-grouped directory of fertility & reproductive medicine specialists in Singapore.
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